Provider Contracting Executive or Senior, DOE

Cambia Health Solutions•Boise, ID

1d•$72,000 - $156,000•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, including strategy development, analytical support, negotiation, and contract administration. The position also builds and maintains relationships with key providers and promotes innovative products and reimbursement methodologies to support an economically sustainable health care system. The role maintains and expands the health care delivery system network through contracts and provider relationships that support cost effectiveness, quality of care, enrollment growth, administrative efficiency, product positioning, and profitability. It develops contracting strategies, monitors contract financial and utilization performance, partners with Health Care Services on improvement plans, reviews reports and issues with provider leaders, supports regional networks and new products, and develops and manages risk arrangements. This is a hybrid position requiring three days per week in the office, with listed office locations in Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, Lewiston, Little Rock, and Springdale. Preference is given to current employees and candidates within commuting distance of certain listed offices or willing to relocate. The Executive level requires a bachelor's degree and five years of relevant experience, or an equivalent combination of education and experience. The Senior level requires a bachelor's degree and seven years of relevant experience, or an equivalent combination. Compensation varies by location and level; the posting lists expected offer ranges and bonus targets for both levels.

Requirements

Provider Contracting Executive: Bachelor's degree in healthcare, business, or a related field and five years of experience in healthcare provider contracting, relations, or an analytical capacity, or an equivalent combination of education and experience.
Provider Contracting Executive Senior: Bachelor's degree in healthcare, business, or a related field and seven years of experience in healthcare provider contracting, relations, or an analytical capacity, or an equivalent combination of education and experience.
Strong understanding of managed care and accountable health system models and their relationship to contracting strategy and reimbursement methodology.
Proven ability to build positive relationships and negotiate successfully with institutional, professional, and ancillary providers.
Competency with varying 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 to develop contracting strategies and organize and manage a portfolio of contracts.
Ability to work in high-pressure circumstances and effectively manage conflict and ambiguity.
Senior level: proficiency building relationships and negotiating successfully with large, complex, market-leading institutional and professional providers.
Senior level: ability to communicate independently and effectively with high-level executives, internally and externally.
Access to a personal mobile device to set up Multi-Factor Authentication upon joining the company.
For work-from-home options, a wired non-satellite, non-cellular internet connection with at least 5 Mbps upload and 10 Mbps download speeds.

Nice To Haves

Experience with AI tools and technologies to enhance productivity and decision-making in professional settings.

Responsibilities

Maintain and expand the health care delivery system 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 financial and utilization performance of contracts and partner 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 to 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 that reduce healthcare expenditures while preserving the best possible care for members, based on potential savings and impact on members and providers.
Develop and manage risk arrangements, including pricing and accountable health system funding arrangements.
For the Senior level, build relationships and negotiate with large, complex, market-leading institutional and professional providers, and communicate independently with high-level internal and external executives.

Benefits

Competitive base pay and bonus opportunities.
Market-leading 401(k) with a significant company match and potential discretionary company-performance contribution.
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 varying by role and tenure, in addition to 10 company-paid holidays.
Up to 12 weeks of paid parental time off, subject to eligibility requirements.
Award-winning wellness programs.
Employee Assistance Fund.
Commute and parking benefits.
Employee resource groups and opportunities to participate in company-supported community outreach programs.