Senior Provider Network Contract Specialist - USFHP

Providence•Renton, WA

About The Position

Responsible for developing and maintaining the Network Plan and provider handbook, evaluating network adequacy, and ensuring the network meets URAC and Department of Defense standards and complies with all elements of the TRICARE Management Activity contract. Builds effective working relationships with community stakeholders to increase resources and collaboration, and represents US Family Health Plan internally and externally. Ensures providers and network members are educated about Health Plan criteria and processes, and is responsible for the Health Plan’s non-clinical utilization management functions and compliance with DoD contract requirements related to network and utilization issues. Plays a key role in provider contracting and network relations. Leads negotiations with network providers across the continuum of care—including hospitals, physician groups, and ancillary services—to establish acceptable reimbursement terms and contract language. Conducts negotiations and completes contracting in a timely manner in accordance with USFHP contracting principles, organizational policies and procedures, and the TRICARE Management Activity contract. The role is with Pacmed Clinics DBA Pacific Medical Centers, part of Providence. Providence describes its culture as patient-focused, whole-person care grounded in understanding, commitment, and mutual respect, and emphasizes empowering caregivers. Benefits are designed to support employees and their families in staying well, growing professionally, and achieving financial security.

Requirements

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

Nice To Haves

Bachelor’s degree in a related field.
Ambulatory medicine experience.
Project management experience.
Contract negotiation experience.

Responsibilities

Develop and maintain the Network Plan and provider handbook.
Evaluate network adequacy and ensure the network meets URAC and DoD standards and complies with the TRICARE Management Activity contract.
Build effective working relationships with community stakeholders to increase resources and collaboration.
Represent US Family Health Plan internally and externally.
Ensure providers and network members are educated about Health Plan criteria and processes.
Manage the Health Plan’s non-clinical utilization management functions.
Ensure compliance with DoD contract requirements regarding network and utilization issues.
Lead provider contract negotiations across the continuum of care, including with hospitals, physician groups, and ancillary services.
Negotiate acceptable reimbursement terms and contract language and complete contracting in a timely manner in accordance with USFHP principles, organizational policies and procedures, and the TRICARE Management Activity contract.