Healthcare Provider Network Contract Manager - Northern California
About the Job
It's a big step forward when you realize that you've earned the trust to lead a team. Now, let's determine just how big that step can be. As a manager within our network contracting team, you'll guide the development and support of Provider Networks as well as unit cost management activities through financial and network pricing modeling, analysis, and reporting. As you do, you'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 7 leader.
Get ready for some significant challenge. This is an intense, fast-paced environment that can be demanding. In addition there are some data challenges and unique problems that need to be solved related to gaps in the process.
- Manage unit cost budgets, target setting, performance reporting and interpreting associated financial models
- Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management
- Evaluate and negotiate contracts in compliance with company templates, reimbursement structure standards and other key process controls
- Ensure that network composition includes an appropriate distribution of provider specialties
- Provide explanations and information to others on difficult issues
- Develops the provider network (physician medical groups, hospitals, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management; and produces an affordable and predictable product for customers and business partners
- Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls
- Establishes and maintains strong business relationships with Hospital, Medical Groups, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties
- Generally, work is self-directed and not prescribed
- Works with less structured, more complex issues
- Serves as a resource to other
- Undergraduate degree or equivalent experience.
- 2+ years of experience in a network management-related role, such as contracting or provider services
- 2+ years of experience in fee schedule development using actuarial models
- 2+ years of experience using financial models and analysis to negotiate rates with providers
- Intermediate level of knowledge of claims processing systems and guidelines
- 2+ years of experience in performing network adequacy analysis
- Previous contracting experience