Provider Contracting Executive or Senior, DOE

Cambia Health Solutions • Boise, ID

1d • Hybrid

About The Position

Cambia is hiring a Provider Contracting Executive or Senior to join its Network Management team. The role manages contracting relationships with physicians, physician groups, institutions, and ancillary providers through strategy development, analysis, negotiation, and contract administration. It also builds and maintains provider relationships and promotes innovative products and reimbursement methodologies to support a person-focused, economically sustainable health care system.

The position is hybrid, with three days per week in the office, at Cambia offices in Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, Lewiston, Little Rock, or Springdale. Preference is given to current employees and candidates within commuting distance of Salt Lake City, Boise, Fargo, Lewiston, Little Rock, or Springdale, or those willing to relocate.

The Executive level requires a bachelor’s degree in healthcare, business, or a related field and five years of relevant healthcare industry experience, or an equivalent combination of education and experience. The Senior level requires the same degree and seven years of relevant experience, or an equivalent combination. Senior candidates are additionally expected to have experience with large, complex, market-leading providers and to communicate effectively with high-level executives.

Compensation varies by location and level. The expected offer range is $85,000–$115,000 for Executive under the national pay structure, or $76,500–$103,500 under the regional structure. For Senior, the expected offer range is $102,000–$138,000 under the national structure, or $91,800–$124,200 under the regional structure. Bonus targets are 10% for Executive and 15% for Senior.

Cambia describes its culture as purpose-driven, supportive, and focused on trust and innovation. The compensation package includes competitive base pay, bonus opportunities, and benefits. Employees must have a wired, non-satellite and non-cellular internet connection with minimum upload and download speeds of 5 Mb and 10 Mb, respectively, to use work-from-home options. New hires also need access to a personal mobile device for required multi-factor authentication.

Requirements

• Bachelor’s degree in healthcare, business, or a related field, and five years of experience in healthcare industry provider contracting, relations, or an analytical capacity for the Executive level; alternatively, an equivalent combination of education and experience.
• Bachelor’s degree in healthcare, business, or a related field, and seven years of experience in healthcare industry provider contracting, relations, or an analytical capacity for the Senior level; alternatively, an equivalent combination of education and experience.
• Strong understanding of managed care and accountable health system models and how they relate to contracting strategy and reimbursement methodology.
• Ability to build positive relationships and negotiate successfully with institutional, professional, and ancillary providers.
• Competency with payment methodologies and value-based contracting, including Pay for Quality/Performance, DRG, APC, ASC, capitation, fee for service, RBRVS, per diem, and per case.
• Ability to analyze financial, quality, and utilization data and use it to develop contracting strategies.
• Ability to organize and manage a portfolio of contracts.
• Ability to work in high-pressure circumstances and manage conflict and ambiguity effectively.
• For the Senior level, ability to build relationships and negotiate successfully with large, complex, market-leading institutional and professional providers.
• For the Senior level, ability to communicate independently and effectively with high-level executives internally and externally.

Nice To Haves

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings is highly desired for the Senior level.

Responsibilities

• Maintain and expand the health care delivery network by negotiating contracts and cultivating provider relationships that support cost effectiveness, quality of care, enrollment growth, administrative efficiency, product positioning, and profitability.
• Develop long- and short-range contracting strategies for each assigned delivery system.
• Monitor contract financial and utilization performance and work with the Health Care Services division to develop improvement plans.
• Meet regularly with key provider leaders as the primary client manager to review cost and utilization reports, prepare analyses, research issues, and recommend strategies.
• Build and maintain regional networks that support new products, apply knowledge of market pricing, and communicate the strategic benefits of participation to providers.
• Work with provider consultants and representatives to ensure contracts are administered appropriately and improvement plans are managed.
• Support initiatives to reduce health care expenditures while preserving the best possible care for members, considering potential savings and effects on members and providers.
• Develop and manage risk arrangements, including pricing and accountable health system funding arrangements.

Benefits

• Medical, dental, and vision coverage for employees and eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Paid time off that varies by role and tenure, in addition to 10 company-paid holidays.
• 401(k) retirement plan with company match and a potential discretionary contribution based on company performance; no vesting period.
• Up to 12 weeks of paid parental time off, subject to eligibility requirements.
• Wellness programs that reward participation.
• Employee Assistance Fund.
• Commute and parking benefits.
• Competitive salary and bonus opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior