Provider Services MA

CareSource

4d•$83,000 - $132,800

About The Position

Job Summary: The Health Partner Network Manager IV acts as the lead negotiator for high value, strategic health partners. Essential Functions: Execute the contracting strategy, develop provisions based on cost, quality/analysis and monitor key metrics for the assigned Market. Lead for identified Market contracting strategic initiatives under the direct supervision of the Market Director or Vice President. Create, execute and administer risk based and value based reimbursement (VBR) strategies as directed by the senior leadership Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting initiatives Responsible for provider recruitment, contracting and initiating the loading and credentialing processes Create contract language and review with legal to develop approved contract templates specific to the assigned Market and within the established corporate guardrails Analyze financial data and establish rates in collaboration with Provider Contracting leadership and Finance Negotiate and re-negotiate hospital, ancillary, physician and behavioral health contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies Market lead for recruitment activities to support new products and product expansion. Support team members through participation in negotiations that support the strategic initiatives. Responsible for complying with all regulatory requirements Perform gap analysis to ensure no gaps and/or sanctions occur; identify potential providers to recruit that will fill the gaps; identify and implement solutions that mitigate risk; develop corrective action plans as needed Participate in training sessions for providers and staff as appropriate Support the contracting requirements of the corporation for geographic regions and products Knowledgeable of federal and state laws and regulations pertaining to provider contracting Assist with development and review of payment policies and provider notifications As requested, become a Subject Matter Expert on specific provider types Mentor and/or train new hires Perform any other job duties as requested

Requirements

Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is required
Minimum of five (5) years of Healthcare experience, to include two (2) years of work experience in provider relations or provider contracting
Intermediate proficiency level with Microsoft Outlook Word, and Excel
Knowledge of Provider Network Management Processes & Services
Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making
Strong negotiation skills
Effective oral and written communication skills
Critical listening and thinking skills
Training/teaching skills
Time management skills
Must have valid driver’s license, vehicle and verifiable insurance.
Employment in this position is conditional pending successful clearance of a driver’s license record check and verified insurance.
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position.
CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment.

Nice To Haves

Master’s Degree is preferred
Managed care experience is highly preferred

Responsibilities

Execute the contracting strategy, develop provisions based on cost, quality/analysis and monitor key metrics for the assigned Market.
Lead for identified Market contracting strategic initiatives under the direct supervision of the Market Director or Vice President.
Create, execute and administer risk based and value based reimbursement (VBR) strategies as directed by the senior leadership
Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting initiatives
Responsible for provider recruitment, contracting and initiating the loading and credentialing processes
Create contract language and review with legal to develop approved contract templates specific to the assigned Market and within the established corporate guardrails
Analyze financial data and establish rates in collaboration with Provider Contracting leadership and Finance
Negotiate and re-negotiate hospital, ancillary, physician and behavioral health contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
Market lead for recruitment activities to support new products and product expansion.
Support team members through participation in negotiations that support the strategic initiatives.
Responsible for complying with all regulatory requirements
Perform gap analysis to ensure no gaps and/or sanctions occur; identify potential providers to recruit that will fill the gaps; identify and implement solutions that mitigate risk; develop corrective action plans as needed
Participate in training sessions for providers and staff as appropriate
Support the contracting requirements of the corporation for geographic regions and products
Knowledgeable of federal and state laws and regulations pertaining to provider contracting
Assist with development and review of payment policies and provider notifications
As requested, become a Subject Matter Expert on specific provider types
Mentor and/or train new hires
Perform any other job duties as requested