Provider Contract Manager II

Medica•Madison, WI

5d•Hybrid

About The Position

The Provider Contract Manager II performs intermediate-level contracting, analysis, and provider relationship responsibilities that support building a competitive, compliant, and cost-effective network. This role evaluates network adequacy, conducts routine provider negotiations, and manages contracting workflows with moderate independence. It collaborates across business areas to ensure contracts align with reimbursement standards, regulatory requirements, and operational needs. As a developing professional, the Contract Manager II handles moderately complex contracting assignments and contributes meaningfully to network performance and provider engagement. Develop and maintain provider networks yielding a competitive, geographically stable network that achieves objectives for unit cost performance and trend management. Produces an affordable and predictable network for customers and business partners. Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties. Performs other duties as assigned.

Requirements

Bachelor's degree or equivalent experience in related field
3+ years of work experience beyond degree in contract negotiations and healthcare
WI market knowledge within provider contracting
History of Basic Health plan operations and/or provider operations experience
Excellent communication (written, verbal and presentation) skills
Ability to work independently, make sound judgment calls and determine when things should be escalated
Proven track record of cultivating and maintaining effective, collaborative external relationships where the parties trust information that’s conveyed
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
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

Responsibilities

Support Network Optimization: Evaluate market dynamics and provider availability to support a competitive, geographically adequate network. Partner with internal teams to ensure network configuration supports product and regulatory requirements.
Manage Routine Provider Contract Negotiations & Updates: Review proposed terms, reimbursement structures, and negotiation considerations in alignment with company standards. Conduct negotiations with physicians, ancillary providers, and smaller facilities to reach compliant agreements. Ensure contracts follow approved templates, legal requirements, and documentation standards. Analyze financial impacts of proposed terms and escalate exceptions as needed.
Maintain Provider Relationships & Support Provider Engagement: Serve as the primary point of contact for routine contract questions and manage provider relationship and escalations. Communicate performance metrics, contract requirements, and network initiatives effectively. Support provider understanding of reimbursement methodologies, operational workflows, and administrative processes. Attend provider meetings or workgroups to build positive, collaborative relationships.
Perform Data Analysis & Develop Market Insights: Analyze claims, cost, and utilization data to detect patterns affecting contracting decisions. Use market intel and benchmarking to support negotiation strategy development. Utilize and edit models to prepare summaries or recommendations for internal review. Track competitor activity and regulatory updates that may impact network structure.
Support Process Improvement & Cross-Functional Collaboration: Suggest enhancements to contracting workflows, tools, or documentation processes. Collaborate with legal, finance, provider operations, and clinical teams to implement contracts smoothly. Participate in initiatives such as value-based contracting, quality programs, or cost-of-care efforts. Share knowledge and best practices with peers to strengthen team capabilities and consistency.