Provider Network Contract Manager III

Medica•St. Louis, MO

2d•$78,700 - $134,900•Hybrid

About The Position

Medica is a nonprofit health plan serving more than a million members across Minnesota, Nebraska, Wisconsin, Missouri, and other communities. The Provider Network Contractor III develops, negotiates, and maintains a competitive and geographically comprehensive provider network that supports affordability, trend management, and business objectives. The role ensures contracts align with organizational reimbursement standards, regulatory requirements, and internal controls while supporting predictable network performance for customers and partners. It builds collaborative relationships with hospitals, physicians, pharmacies, and ancillary providers to support an appropriate specialty mix and network stability. This high-level contributor works independently, manages complex contracting initiatives, and serves as a resource to internal teams. Other duties may be assigned. This is an office role requiring onsite work at the Minnetonka, Minnesota; Madison, Wisconsin; Omaha, Nebraska; or St. Louis, Missouri office an average of three days per week. The full salary grade is $78,700–$134,900, with a typical hiring range of $78,700–$118,020. Placement depends on factors including education, work experience, certifications or licensure, role scope, internal pay equity, and market data. The position may also be eligible for incentive plan compensation. Medica offers a total rewards package that includes medical, dental, vision, PTO, holidays, paid volunteer time off, 401(k) contributions, caregiver services, and other benefits. Medica does not offer work visa sponsorship. Candidates must be legally authorized to work in the United States at the time of application, and employment is contingent on verification of identity and work eligibility. Medica is an Equal Opportunity employer.

Requirements

Bachelor's degree or equivalent experience in a related field.
At least 5 years of work experience within a healthcare environment.

Nice To Haves

Payer/provider contract negotiation experience.
Revenue cycle knowledge and/or experience.
Experience building relationships and establishing trust at all levels.
Health plan operations and/or provider operations experience.
Excellent written, verbal, and presentation communication skills.
A proven ability to cultivate and maintain effective, collaborative external relationships in which parties trust the information conveyed.
A proven track record as a successful contract negotiator for health care services, a provider, or a health plan.
Knowledge of provider contracting components and strategies, including risk-based contracting, financial models, operational impact, and data analytics.
Strong financial, analytical, and problem-solving skills, and an understanding of legal documents.

Responsibilities

Evaluate market dynamics and provider availability to support a competitive, geographically adequate network.
Monitor unit cost performance and trend metrics to align network structure with affordability goals.
Coordinate with internal stakeholders to ensure network decisions support product and regulatory requirements.
Assess contract terms, reimbursement structures, and negotiation strategies in alignment with company standards and financial targets.
Lead negotiations with hospitals, physicians, and ancillary providers to reach sustainable, mutually beneficial agreements.
Ensure contracts adhere to templates, legal requirements, and internal process controls.
Conduct financial analyses to evaluate the cost and utilization impacts of proposed and final contract terms.
Build relationships with contracted providers and serve as a key contact for concerns, expectations, and issue resolution.
Facilitate communication about performance data, contract requirements, and network initiatives.
Support provider understanding of reimbursement models and operational workflows.
Represent the organization in provider meetings, partnership discussions, and network-related forums.
Analyze claims, cost, and utilization patterns to identify opportunities to improve contracting or network performance.
Use market intelligence and benchmarking to support negotiation strategies and decision-making.
Use and edit models to prepare summaries and recommendations for leadership based on financial and operational data.
Monitor competitor actions and regulatory changes that may affect the network.
Recommend improvements to contracting processes, documentation practices, and workflow efficiency.
Partner with legal, finance, provider operations, and medical management teams to support smooth contract implementation.
Support cross-team initiatives such as value-based contracting, quality programs, and cost-of-care strategies.
Share expertise and guidance with colleagues to strengthen team capabilities and contracting effectiveness.
Perform other duties as assigned.