Senior Network Contracting Analyst
About The Position
The Senior Network Contracting Analyst leads complex physician and specialist contracting initiatives in support of CareMore Health’s mission to deliver high-quality, coordinated, and cost-effective care to Medicare Advantage, Medicaid, and other managed care populations. The role independently manages provider agreement negotiations, implementation, and administration, and provides strategic financial and market analysis to optimize network performance, provider access, and value-based care outcomes. The analyst develops contracting strategies, evaluates financial and market factors, structures provider agreements, and partners with cross-functional teams to ensure agreements are implemented accurately and are operationally ready. The role also serves as the primary contracting contact for assigned provider organizations, supports alternative payment models, leads contracting projects and process improvements, and provides reports and recommendations to Network Management leadership.
Responsibilities
- Lead negotiations for complex primary care and specialty provider agreements, managing the contract lifecycle from strategy development through execution and implementation.
- Develop negotiation strategies by evaluating provider performance, reimbursement methodologies, market conditions, utilization trends, quality metrics, and competitive intelligence.
- Interpret financial models to assess reimbursement scenarios, contract economics, provider performance, and the financial impact of proposed contract terms.
- Structure provider agreements that balance medical expense and affordability initiatives, network adequacy, quality outcomes, regulatory compliance, and long-term provider partnerships.
- Collaborate with Finance, Legal, Compliance, Provider Operations, Configuration, Credentialing, and Clinical leadership to ensure accurate implementation and operational readiness of executed agreements.
- Analyze provider network adequacy, access standards, cost trends, utilization patterns, and market opportunities; recommend contracting initiatives and network optimization strategies.
- Serve as the primary contracting contact for assigned provider organizations, resolving contract interpretation questions, reimbursement issues, and operational concerns while fostering collaborative provider relationships.
- Support development and implementation of value-based payment arrangements, including shared savings, quality incentives, bundled payments, capitation, and other alternative reimbursement models.
- Identify contracting risks and opportunities and recommend solutions to improve provider performance, member access, quality outcomes, and financial sustainability.
- Lead cross-functional contracting projects and process improvement initiatives that enhance operational efficiency, contract governance, and data integrity.
- Prepare executive-level reports, financial analyses, and contracting recommendations for Network Management leadership.
- Stay current on CMS regulations, state Medicaid requirements, healthcare market trends, and industry best practices affecting provider contracting and reimbursement.
- Understand how provider relationships interact with CareMore strategic initiatives.
- Pivot quickly and prioritize workload in line with changing organizational objectives.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
