Network Development Contractor

GuideWell•Fort Lauderdale, FL

15h

About The Position

This role is accountable for developing and executing the provider contracting and implementation strategy for a defined market. The position will be responsible for participating in the development of the network management strategy which includes aspects of technology, product, utilization management, and value-based care/fee for service, membership growth, marketing, compliance, and member and provider experience. Important to Know Must reside in South Florida Occasional travel may be required for client site visits, meetings, training and events

Requirements

5+ years related work experience in developing and maintaining provider contracts and/or relationships
Related Bachelor’s degree or additional related equivalent work experience
Experience of provider payment programs and billing practices
Experience of insurance products and network configurations
Excellent verbal and written communication skills
Experience in issue resolution with ancillary and hospital based providers
Experience interpreting analytical data
Valid Driver License
Frequent local travel with occasional overnight stays

Nice To Haves

3 or more years of experience negotiating standard and non-standard provider contracts
Experience negotiating with third-party representatives, hospital-based provider organizations and or ancillary provider organizations
Experience using the Network Management Simulation Tool (SIM)
Medicare and Medicaid experience
Intermediate level Excel skills
Knowledge of negotiation best practices, both in-person and in written form, that considers cultural norms and the client's best interests
Demonstrated experience drafting, negotiating, and interpreting various contracts, ensuring compliance with legal and contractual requirements, and providing oversight to ensure that all contractual commitments are met.

Responsibilities

Negotiate contract terms and establish contractual relationships with providers with moderate complexity
Coordinate the implementation of contractual arrangements with internal business partners
Establish and maintain business relationships with assigned providers that promotes positive provider engagement and enables achieving business objectives
Resolve issues involving contract disputes, audit, provider performance and compliance in accordance with company policies and procedures
Assist with the design, development, management and/or implementation of provider network configurations to achieve business objectives
Implement medical cost management initiatives as directed
Monitor provider performance and implement corrective action, if applicable, to improve provider performance
Assess and analyze data to ascertain, financial and quality performance
External execution of operational initiatives: self- service tools, retail, projects
Proactively communicates and trains provider on administrative policies, business processes, capabilities and initiatives
Perform site visits to address member complaints/potential quality issues
Support professional organization relationship events
Execute provider facing deliverables for key projects

Benefits

As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
To support your wellbeing, comprehensive benefits are offered.
As an employee, you will have access to:
Medical, dental, vision, life and global travel health insurance
Income protection benefits: life insurance, short- and long-term disability programs
Leave programs to support personal circumstances
Retirement Savings Plan including employer match
Paid time off, volunteer time off, 10 holidays and 2 well-being days
Additional voluntary benefits available; and a comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws.
Benefits may vary based on the state in which work is performed.
Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation.
We also conduct regular annual reviews with pay for performance considerations for base pay increases.