Manager, Provider Contracting (St. Louis, MO)

Medica•Saint Louis, MO

61d•$98,400 - $168,600•Hybrid

About The Position

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. The Manager, Provider Contracting is accountable for the staff responsible for the strategy, development, execution and management of alternative contracting, including, but not limited to, total cost of care (TCOC) contracting negotiations, bundles, alternative payment arrangements and network development. Provider contracting is the foundation for development of alternative payment arrangements as well as the financial strategy that moves reimbursement from total fee for service to risk sharing with providers. This type of contracting is key in developing products and financial strategies around provider relationships and supports the organization's market strategies and financial objectives. The contracting model for alternative arrangements is complex and could contain both cost/utilization factors as well as quality measurement performance. The incumbent is required to identify and cultivate key provider relationships for consideration of differential payment terms. The Manager, Provider Contracting requires an ability to think strategically and have a thorough understanding of the financial modeling and impacts in the execution of alternative arrangements. Performs other duties as assigned.

Requirements

Bachelor's degree in Healthcare, Finance, or Economics, or equivalent experience in related field
5 years of work experience beyond degree in contract negotiations and healthcare
Proven track record as a team leader with staff management skills
Excellent communication (written, verbal and presentation) skills
Proven track record of cultivating and maintaining effective, collaborative external relationships where the parties trust information that's conveyed
A proven track record as a successful contract negotiator for health care services, provider or health plan
Flexibility and creativity in developing effective contracting terms
Knowledge of provider contracting components and strategies such as but not limited to risk-based contracting, financial models, operational impact and data analytics
Demonstrated understanding of complex financial arrangements and quality programs across health care products
Strong financial, analytical and problem solving skills, and understanding of legal documents
Strategic-thinking skills with the ability to conceptualize a wide range of scenarios and the ability to analyze each scenario to come up with the most viable option
An understanding and appreciation for standardizing processes to generate efficiencies and improve service levels

Responsibilities

Lead Contract Management Function
Oversees contract managers to successfully execute contracting arrangements, which include alternative payment terms, with providers in a timely, accurate fashion
Provides first level of escalation during contract negotiations
Oversees network development activities
Provides leadership to contracting staff by communicating organizational strategy and actions to execute strategy
Coordinates network contracting activities with Provider Finance, Operations and Legal in understanding data analytics, operational compatibility and sound legal instruments
Manage Department Activities
Establishes and improves processes and policies and procedures
Provides staff guidance on negotiating contracts in collaboration with appropriate internal areas
Provider Relations
Maintains positive working relationships with Medica's key providers