Manager Provider Contracting

Company :

Job Description : 

JOB SUMMARY

This job is responsible for directing and overseeing the negotiation and execution of the plan’s contracts with health care providers that drive high-quality care for our members, while maintaining a competitive cost structure for our company. This role requires accountability, good judgement and instincts, high standards, conviction, tenacity, and excellent communication skills. The ideal candidate must coach and develop staff, while encouraging creativity, new perspectives, and collaboration in order to successfully support enterprise and market objectives and strategy.            

This role requires the candidate to be a current resident of the state of West Virginia
ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
• Direct and oversee negotiation of contracts, taking the lead in complex negotiations as appropriate. Develop and manage the design and implementation of provider network strategies and reimbursement methodologies, including alternative payment methodologies aimed at controlling health care costs and evaluate the impact on providers.
• Review provider network regulatory reports relating to among other things, access and availability, geo access and panel size to ensure the plan’s network is adequate.
• Develop and oversee provider recruitment strategy.
• Review and revise all provider contractual templates. Ensure department compliance with state contractual requirements. 
• Develop strategic relationships with key provider constituents and maintain critical communications with providers in sensitive contract discussions.
• Collaborate with various departments including but not limited to Provider Relations, Claims, Program Integrity, Utilization Management.
• Stay current on new reimbursement strategies and best practices used across the industry.
• Other duties as assigned or requested.

EXPERIENCE

Required

• 5 years in Healthcare Contracting or related field
• 5 years in a management role

Preferred

• None

SKILLS

• Knowledge of contracting concepts, reimbursement methodologies, including alternative payment methodologies and value-based reimbursement.
• Ability to read and comprehend various provider contract types including correspondence, law material, and reports.
• Working knowledge of the state of Delaware Medicaid Managed Care contract and managed care in general
• Able to concentrate on detailed and complicated contractual matters on a frequent basis with occasional interruptions. Attention to detail is constant in this position.
• Able to proofread typed material for contextual, grammatical, typographical or spelling errors.
• Able to cope with and work in a fast-paced highly demanding work environment.
• Able to analyze and interpret moderate to complex information and/or data on a frequent basis.
• Must possess excellent verbal and written communication skills, organizational, multi-tasking, and time management skills.
• High degree of business maturity and demonstrated confidentiality.

EDUCATION

Required

• Bachelor's Degree in Business Administration/Management, Government, or related field OR  6 years of related and progressive experience in lieu of Bachelor’s degree

Preferred

• Master's Degree in Business Administration/Management, Healthcare Administration, Government, or related field

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

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