Physical Health PN Contract Manager (Remote NC)

Vaya Health • NC

100d

About The Position

The Physical Health PN Contract Manager identifies and contracts with physical health providers to develop the physical health provider network yielding a geographically broad access, stable network that achieves objectives for unit cost performance, and produces an affordable and predictable product for members and business partners. This role evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. The Physical Health PN Contract Manager initiates, negotiates, and executes physician, hospital, ancillary and/or other provider contracts and agreements for Vaya Health. This position works on problems of diverse scope and complexity ranging from moderate to complex. Strategically approach the provider community and prioritize network needs both quantitatively and qualitatively.

Requirements

• Bachelor’s degree in Public Administration, Business or Human Services required.
• 2-5 years of relevant network management experience including contracting with Healthcare Providers and network administration in a healthcare company.
• Proficiency in analyzing, understanding, and communicating financial trends.
• Strong customer service skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• High level of proficiency in Microsoft Office applications.
• Prior demonstrated success in provider relations with large provider groups and/or ancillary providers.
• Expert level of knowledge of CMS reimbursement methodologies.

Nice To Haves

• Master’s degree preferred.
• Extensive provider contracting skills, including contract preparation and implementation, financial analysis, and rate proposal development preferred.
• Experience with Medicaid and Value Based Contracting utilizing financial modeling in making rate decisions preferred.

Responsibilities

• Establish and maintain strong business relationships with Health Systems (Hospital, Physician and Ancillary providers).
• Negotiate and re-negotiate provider organization contract terms, payment structures, and reimbursement rates to providers.
• Analyze financial impact of contracts and terms.
• Maintain contracts and documentation within a tracking system.
• Advise executives to develop functional strategies on matters of significance.
• Function as the single point-of-contact for all on-going contractual and service issues as needed by providers.
• Facilitate provider education and training to increase provider familiarity and satisfaction with Vaya’s systems and strategies.
• Create and review trend analyses and summaries for decision-making purposes.
• Interface with Vaya network and department leaders to align provider development needs and projects.
• Study and design innovative programs to create and enhance access to care.
• Work with provider organizations and community stakeholders to successfully implement new programs and improve member access to care.
• Apply network configuration and incentive-based payment models as appropriate to improve quality and efficiency.
• Assist others to resolve highly complex or unusual business problems that affect major functions or disciplines.
• Exercise independent judgment and decision making on complex issues regarding job duties and related tasks.

Benefits

• Remote work opportunity.
• Flexible working hours.
• Salary depending on qualifications & experience.

What This Job Offers

• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 501-1,000 employees