Senior Manager - Contracting & Network Development

About the company:

Our client is into health care. Provide access to high quality healthcare, innovative programmes and a wide range of health solutions that help families and individuals get well, stay well and be well. 

Position Purpose
Lead, negotiate, and manage multiple large hospitals and medical groups, physician, and/or ancillary contracting activities in accordance with Corporate, health plan, and state guidelines. 

Responsibilities: 
  • Oversee provider contracting activities to ensure efficiency and maintain compliance with Company policies and standards, government laws and regulations
  • Develop and implement a network development plan for multiple regions, for a set of providers and identify and initiate contact with potential providers
  • Lead negotiations, implementations, and ongoing monitoring of hospitals and providers to maximize business relationships and opportunities for multiple regions
  • Oversee contract configuration to ensure accurate claims adjudication and facilitate the organization of provider focus groups
  • Ensures compliance with national contracting standards, reimbursement standards, provider set-up rules, exception process and use of model contract language
  • Perform financial analyses of multiple business units to identify medical cost improvement opportunities and develop and execute contracting action plans to achieve results
  • Oversee and train in high level physician and hospital contracting

Qualifications:


  • Education: Bachelors’ degree in healthcare administration, business administration, marketing or related field
  • Experience:. 6+ years of contracting experience or provider relations in a healthcare and/or managed care environment. Knowledge of contracting language and the principles of negotiation. Familiarity with managed care, State and/or Federal health care programs.

  • License/Certification: Current state driver’s license. 

Our client and us gives  an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Employee Status:

Regular

Job Level:

Manager

Job Type:

Regular 


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