Provider Relations and Contracting Manager - Wisconsin

Hudson Hospital • Bloomington, MN

14h • $45 - $67

About The Position

HealthPartners is hiring a Wisconsin-based Manager of Provider Relations and Contracting to manage strategic relationships with providers in eastern Wisconsin. The role encompasses provider contracting, financial analysis, operations management, strategic partnerships, and coordination with HealthPartners and contracted medical groups.

The manager develops network contracting strategies and reimbursement methodologies, negotiates provider contracts, supports compliance with Medicare product requirements, and creates product-specific networks. The role coordinates communications among the health plan and provider organizations, oversees day-to-day provider operations, and investigates and resolves inquiries about provider care. It also supports quality and utilization management through provider trend analysis and action planning.

The position independently manages administrative functions for Wisconsin contracted providers, including network strategy, financial analysis, negotiations, contract drafting and monitoring, provider relations, contract implementation and maintenance, credentialing information, and contract filing. It monitors contract compliance and claims payment, addresses noncompliance, and participates in year-end contract settlements where appropriate. It also manages provider relationships and supports medical and department leaders with communications and operations.

The manager contributes to annual planning, strategic development projects, and business continuity and disaster recovery planning and testing. The role includes project planning and leadership, and supervision and mentoring of direct reports, with future responsibility for employee-related decisions and performance management. The position primarily supports providers in eastern Wisconsin and requires travel throughout eastern and central Wisconsin, as well as occasional travel to HealthPartners’ corporate office in Bloomington, Minnesota.

HealthPartners describes itself as a nonprofit, integrated health care organization providing health insurance in six states and care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. It also supports research and education through HealthPartners Institute. The organization emphasizes inclusion, diversity, health equity, and community partnership.

Requirements

• Bachelor’s degree in health care administration, business administration, or another relevant field.
• At least seven years of experience working in the health care industry, including three years in a provider relations or provider administrative role.
• Previous management experience with independent responsibility for planning and developing a key company function.
• Strong analytical and financial modeling skills.
• Ability to develop and evaluate contracting strategies.
• Strong oral and written communication skills, including effective group presentations and consensus building.
• Excellent team leadership skills and strong interpersonal effectiveness.
• Ability to work independently and make decisions that support successful provider relationships and HealthPartners’ goals.
• Must reside in eastern Wisconsin near the Milwaukee area.
• Travel throughout eastern and central Wisconsin is required; occasional travel to Bloomington, Minnesota, is also required.

Nice To Haves

• Strong financial and systems background.
• Previous experience in provider contract negotiations.
• Previous experience in the health care industry.
• An additional two years of experience in network development for specific products, such as workers’ compensation.

Responsibilities

• Establish and maintain contractual and strategic relationships with HealthPartners’ eastern Wisconsin provider network.
• Develop and implement network contracting strategies aligned with HealthPartners’ objectives.
• Develop and implement reimbursement methodologies for Wisconsin providers.
• Negotiate contract terms with eastern Wisconsin providers.
• Work with government programs management to support compliance with Medicare product requirements and regulations.
• Create product-specific networks as directed by HealthPartners initiatives.
• Coordinate communications between the health plan and primary care, specialty, and institutional providers.
• Manage day-to-day operational needs related to eastern Wisconsin providers.
• Supervise and mentor direct reports, including service specialists and contract consultants when applicable.
• Manage administrative functions for Wisconsin contracted providers, including network strategy, financial analysis, negotiations, contract drafting and monitoring, provider relations, and communications.
• Manage implementation of provider contracts and develop systems, policies, and procedures to support implementation across internal departments.
• Manage contract maintenance and filing, credentialing information collection, provider listings, and contract currency and regulatory compliance.
• Monitor provider and HealthPartners compliance with contract provisions and claims payments; take corrective action when necessary and participate in year-end contract settlements where appropriate.
• Develop and implement reimbursement methodologies, including capitation, case rates, fee schedules, per diems, Ambulatory Patient Classifications, and Diagnostic Related Groups.
• Monitor, analyze, and interpret provider financial and utilization patterns and implement corrective actions as needed.
• Manage operational, financial, and administrative relationships with providers; support medical directors and department heads in coordinating communications and operations.
• Participate in annual planning for the department, Contracted Care Division, and HealthPartners.
• Lead strategic development projects, including project planning, problem solving, timelines, responsibilities, implementation, and participation in strategic planning.
• Participate in and create business continuity and disaster recovery plans and tests.
• Investigate, mediate, and resolve inquiries regarding the delivery of care by providers.
• Support the Quality Utilization Management Department in analyzing provider trends and developing action plans.
• Travel throughout eastern and central Wisconsin and occasionally to the corporate office in Bloomington, Minnesota.
• Ensure compliance with organizational and departmental policies and procedures; future supervisory responsibilities include hiring, transfer, layoff, promotion, discipline, discharge, training, rewards, and performance reviews.

Benefits

• Comprehensive benefits supporting health, time off, retirement planning, and continuous learning opportunities.
• Benefits intended to support physical, mental, emotional, and financial well-being.

What This Job Offers

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