Senior Provider Network Contract Specialist - USFHP

Providence•Renton, WA

About The Position

Responsible for the development and maintenance of the Network Plan, the provider handbook, for evaluation of the adequacy of the network, for assuring that the network meets URAC and DoD standards, and that there is compliance with all elements of the TRICARE Management Activity contract. Understands the attitudes and values of the community and establishes effective working relationships with stakeholders to increase resources and collaboration. Acts as a representative and spokesperson for US Family Health Plan both internally and externally. Responsible for assuring providers and network members are educated in Health Plan criteria and processes. Responsible for the non-clinical utilization management functions of the Health Plan. Responsible for compliance with the DoD contract regarding network and utilization issues. Responsible for a key role in provider contracting and network relations. Leads contract negotiations for acceptable reimbursement terms and contract language with all network providers across the continuum of care (i.e., hospitals, physician groups, and ancillary services). Will conduct negotiations and complete the contracting process in a timely manner in accordance with USFHP contracting principles, organizational policies and procedures, and all elements of the TRICARE Management Activity contract. Providence caregivers are not simply valued – they’re invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Requirements

5 years of Managed care operations.
Extensive experience and understanding of capitated medicine, contracted networks, and health plan contracts.

Nice To Haves

Bachelor’s Degree in related field
Ambulatory medicine
Project management
Contract negotiation

Responsibilities

Development and maintenance of the Network Plan and provider handbook.
Evaluation of the adequacy of the network.
Assuring the network meets URAC and DoD standards.
Ensuring compliance with all elements of the TRICARE Management Activity contract.
Establishing effective working relationships with stakeholders to increase resources and collaboration.
Acting as a representative and spokesperson for US Family Health Plan.
Assuring providers and network members are educated in Health Plan criteria and processes.
Performing non-clinical utilization management functions.
Ensuring compliance with the DoD contract regarding network and utilization issues.
Playing a key role in provider contracting and network relations.
Leading contract negotiations for acceptable reimbursement terms and contract language with all network providers.
Conducting negotiations and completing the contracting process in a timely manner.