Manager - Contracting

About the Role:

Lead recruitment and negotiation of PCP, specialist, and ancillary provider contracts per company and state guidelines, while building new networks and optimizing existing ones, managing provider rosters and oversee post-contract intake, including credentialing, contracting, and loading.

Our Values:

- Put Patients First

- Empower Entrepreneurial Provider and Care Teams

- Operate with Integrity & Excellence

- Be Innovative

- Work As One Team

What You'll Do

- Manage end-to-end recruitment and negotiation of regional and/or national providers (PCP, specialists, and ancillary providers) from sourcing through contract execution in accordance with corporate, health plan, and state guidelines for assigned regions.

- Manage net new contracts and amendments to support network operations and provider and member growth, while coordinating with contracting, legal, provider data management, credentialing, and other applicable internal teams to ensure all new contracts and amendments are loaded completely, accurately, and on time.

- Manage relationships with high-value network providers by indirectly supporting their operational, financial, and clinical success through provider relations teams and the market leader.

- Define, launch, and monitor network reporting for assigned functions including network adequacy goals, metrics, and identifying targets for network build-out, management of rosters, and driving provider question and issue resolution.

- Initiate and lead occasional meetings with health plans and corporate teams, including executive management, to review provider performance data, scorecards, and partnership strategy.

Qualifications

- Bachelor’s degree in Health Administration, Business Administration, related field or equivalent experience.

- 5+ years of contracting, contract analysis, provider relations, or provider experience, preferably in a hospital, physician’s office, physician group or ancillary services setting.

- Experience in project management, managed care, State and/or Federal health programs and working knowledge of contracting language and principles of negotiation.

- Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

- Has strong negotiation skills (negotiate favorable terms while balancing implications such as cost, quality, access with a strong understanding of reimbursement models).

- Has healthcare industry knowledge (foundational understanding of provider operations, insurance products, regulations and familiarity with VBC, FFS, capitation, and risk contracting).

- Has experience in contract management and compliance (skilled in drafting, reviewing, and managing terms).

Environmental Job Requirements and Working Conditions

- Our organization follows a remote work structure where the expectation is to work at home on a weekly basis with monthly/quarterly travel to the office. The office is located at 2929 Mossrock, Suite 200, San Antonio, TX 78230.

- The total compensation target pay range for this role is $100,000 - $120,000 annually and represents our national target range for this role.

Originally posted on Himalayas