Provider Network Contractor II
About The Position
Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.
Requirements
- Bachelor's degree or equivalent experience in healthcare management/administration or healthcare related field
- Plus 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
- 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.
Nice To Haves
- Health plan negotiation experience preferred
Responsibilities
- Develop and maintain provider network yielding a competitive, geographic, 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.
- Develop and maintain provider network yielding a competitive, geographic, stable network that achieves objectives for performance and growth.
- Builds and maintains positive relationships with providers.
- Processes and negotiates needed provider contract amendments and assignments as requested; and communicates contract terms and provisions to provider and all needed internal staff.
- Updates and maintains contract tracking system, records information sharing system and contracting calendar within contract metric timeframes.
Benefits
- competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
