Manager, Provider Network Optimization

Centene

3d•Remote

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Lead, negotiate, and manage multiple hospital, large medical group, physician, school and/or ancillary contracting activities in accordance with Corporate, health plan, and state guidelines. Oversee all activities of the contracting department Develop and implement a network development plan for an assigned region and set of providers and identify and initiate contact with potential providers Negotiate contracts with interested providers utilizing model provider agreements, and follow up on contracts Lead negotiations, rate modeling, implementation and ongoing monitoring of assigned group of providers to maximize business relationships and opportunities Oversee provider set-up and contract configuration to ensure accurate claims adjudication and facilitate the organization of provider focus groups Evaluate and monitor providers' performance standards and financial performance of contracts Ensures compliance with national contracting standards, reimbursement standards, provider set-up rules, exception process and use of model contract language Perform financial analyses to identify medical cost improvement opportunities and develop and execute contracting action plans to achieve results Performs other duties as assigned Complies with all policies and standards

Requirements

Bachelor's degree in Healthcare Administration, Business Administration, Marketing, related field or equivalent experience.
4+ years of provider relations/contracting experience in a healthcare and/or managed care environment.
Working knowledge of contracting language and the principles of negotiation.
Familiarity with managed care, State and/or Federal health care programs.
Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
Valid driver's license.
Candidates must be in the state of Michigan to be considered for this role.

Responsibilities

Lead, negotiate, and manage multiple hospital, large medical group, physician, school and/or ancillary contracting activities in accordance with Corporate, health plan, and state guidelines.
Oversee all activities of the contracting department
Develop and implement a network development plan for an assigned region and set of providers and identify and initiate contact with potential providers
Negotiate contracts with interested providers utilizing model provider agreements, and follow up on contracts
Lead negotiations, rate modeling, implementation and ongoing monitoring of assigned group of providers to maximize business relationships and opportunities
Oversee provider set-up and contract configuration to ensure accurate claims adjudication and facilitate the organization of provider focus groups
Evaluate and monitor providers' performance standards and financial performance of contracts
Ensures compliance with national contracting standards, reimbursement standards, provider set-up rules, exception process and use of model contract language
Perform financial analyses to identify medical cost improvement opportunities and develop and execute contracting action plans to achieve results
Performs other duties as assigned
Complies with all policies and standards