Manager Regional Contracting

Univera Healthcare•Buffalo, NY

About The Position

This position negotiates, plans, directs, and controls provider contracting activities, including facility, professional, ancillary, and value-based arrangements. It helps ensure the Company acts as a prudent purchaser of services by developing and maintaining contractual and payment relationships with assigned providers. The role analyzes contracting needs, recommends and implements approved strategies and terms, resolves issues, identifies process improvements, and monitors contract implementation and compliance. Within assigned parameters, the Regional Contractor may be responsible for finalizing contracts within an established budget and may be authorized to act and speak on the Company’s behalf. The position works across a highly matrixed network of internal and external stakeholders, supports effective engagement and communication, and may assist with incentive payment design, program development, and project coordination. It requires current knowledge of healthcare, financial models, provider organizations, contracts, the Corporation’s products, and applicable legislative and regulatory requirements. The role also supports the Health Plan’s community initiatives and nonprofit goals, protects member privacy, and upholds the Lifetime Healthcare Companies’ mission, values, and Code of Conduct.

Requirements

Bachelor’s degree in Health Care Administration, Finance, Public Administration, or a relevant field; five years of related experience may substitute for the degree.
Three to five years of experience in reimbursement, finance, contract negotiations, or related work with hospitals and providers.
Two years of leadership or management experience.
Excellent communication, presentation, problem-solving, and negotiation skills.
Ability to work constructively with hospital administrators, provider-company owners, physicians, provider organization leaders, and other providers of health and health-related services and equipment.
Demonstrated understanding of industry trends, including healthcare operations, insurance products, and provider entities.
Experience with private and governmental reimbursement methodologies and ability to understand and use financial models.
In-depth knowledge of regional provider networks and relationships.
Ability to remain composed and professional in high-stress and contentious situations.
Knowledge of CMS and New York State pricing methodologies and regulations.
Knowledge of medical management programs and their impact on providers, members, and contract compliance.
Knowledge of Health Plan strategies and initiatives and ability to explain those relevant to providers.
Knowledge of Blue Cross Blue Shield Association strategies and initiatives and ability to explain those relevant to providers.
Ability to travel across health plan region(s), primarily for same-day meetings and events; some overnight travel may be required.

Nice To Haves

Experience in finance, actuarial work, and provider relations is preferred.

Responsibilities

Build and maintain provider relationships while negotiating effectively to maintain competitive pricing.
Develop and maintain knowledge of providers, the region, and the industry to inform contracting budgets and strategy.
Evaluate and negotiate contracts in accordance with company templates, reimbursement standards, and process controls; act on behalf of the Company when delegated authority.
Analyze network and contracting needs and recommend solutions and strategies to management.
Implement approved contracting strategies and tactics and secure desired contract terms.
Develop, maintain, and communicate contracting roadmaps, including line-of-business, DOH, and CMS strategies and requirements.
Assist with developing and maintaining legal contract templates and amendments, and obtain appropriate and timely internal approvals.
Provide feedback to provider relations and other stakeholders to address provider issues and needs and support contract compliance.
Collaborate with other departments on provider budget models, rate configuration, benefit expense management, and Health Plan strategy.
Assist with incentive payment design, lead program development, and/or coordinate projects as assigned.
Maintain documentation, including status updates, work plans, communication tools, and reports.
Maintain and communicate knowledge of healthcare, financial models, physician organizations, contracts, and Company products.
Promote Health Plan community initiatives and nonprofit goals and represent the Health Plan and its leadership positively.
Support the Lifetime Healthcare Companies’ mission and values, follow the Corporate Code of Conduct, and lead according to Lifetime Way values and beliefs.
Protect member privacy in accordance with corporate policies and procedures.
Maintain knowledge of legislative and regulatory mandates and ensure activities comply with requirements.
Conduct periodic staff meetings and distribute and provide education on departmental and Ethics/Compliance information in a timely manner.
Maintain regular and reliable attendance.
Perform other functions as assigned by management.