Provider Network Contractor II

Medica•Minnetonka, MN

4d•Hybrid

About The Position

Medica is a nonprofit health plan serving over a million members across several states, focusing on personalized healthcare experiences and strong provider partnerships. The company culture emphasizes accountability, data-driven decisions, continuous learning, and collaboration. This role is crucial in developing and maintaining a competitive and stable provider network to achieve cost performance and trend management objectives, ensuring an affordable and predictable network for customers and business partners. The position involves evaluating and negotiating contracts in compliance with company standards, building and maintaining strong relationships with various healthcare providers, and ensuring appropriate distribution of provider specialties within the network.

Requirements

Bachelor's degree or equivalent experience in healthcare management/administration or healthcare related field
3 years of work experience in health insurance/healthcare field
Strong knowledge of managed care products, e.g. HMO, POS, PPO and provider network administration
Expertise working with Microsoft Word, Excel, and Outlook
Strong verbal and written communication
High level of attention to detail and customer service
Maintain regularly assigned work schedule
Must be legally authorized to work in the United States at the time of application.
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role.

Nice To Haves

Health plan negotiation experience preferred

Responsibilities

Develop and maintain provider networks yielding a competitive, geographic, stable network that achieves objectives for unit cost performance and trend management.
Produce an affordable and predictable network for customers and business partners.
Evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.
Establish and maintain strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers.
Ensure the network composition includes an appropriate distribution of provider specialties.
Develop and maintain provider network yielding a competitive, geographic, stable network that achieves objectives for performance and growth.
Build and maintain positive relationships with providers.
Process and negotiate needed provider contract amendments and assignments as requested.
Communicate contract terms and provisions to providers and all needed internal staff.
Update and maintain contract tracking system, records information sharing system and contracting calendar within contract metric timeframes.