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Provider Contracting Manager

Job Type : Direct
Hours : Full Time
Travel : No
Relocation : No
Job Category : Select a Value

Job Description :

The Contracting Manager is responsible for leading a team with the focus of providing contracting, operations and service support to our valued-based providers, business partners, and other internal and external stakeholders to meet our Perfect Service and Provider Experience mission across all products – Commercial, Medicare, Medicaid, and Dual Eligible.



The Contracting Manager will lead and manage a portion of the development of overall provider relationships within a geographic market. Drive strategic initiatives within the provider network and ensure that the alignment of departmental objectives is congruent with the overall business strategy. 

       Lead on key provider contracting initiatives and network operations accountabilities within a market

       Initiate and maintain productive long-term relationships with provider representatives, subscribers, hospitals, account managers and internal sales teams

       Provide effective operations management, ensuring that all contracts are within required legal and compliance guidelines and financial parameters, administered, and serviced within required timing guidelines, operational, and data accuracy parameters

       Apply economic and strategic planning models to all endeavors in your region in order to align business, process, and operational principles with area-specific goals

       Lead teams of direct or indirect reports on key initiatives and projects to achieve assigned goals 


Required Qualifications :

Key Competencies  

       Business and Financial Acumen, Acts Strategically, Collaborates, Lead Positively, Operations a plus, Human capital/management experience, understanding the technical aspects of contract operationalization


Successful candidates will likely have the following:

       At least 3-5 years of provider contracting experience including hospital contracting experience, value based contracting experience, and ACO/Risk Contracting experience

       Network operations experience 

       Effective leadership/management experience including supervisory and teambuilding at a national health plan

       Strong financial acumen with proficiency in analyzing and interpreting financial trends preferably in the provider contracting arena

       Strong operational acumen with proficiency in creating and using data and metrics to drive improvements in team and individual performance

       Knowledge and understanding of Medicare, Commercial, Medicaid business including reimbursement methodologies and processes

       Demonstrated contract preparation and executive level presentation skills

       10% or more travel

       Operations experience related to data integrity of a provider network

       Bachelor’s Degree in Business, Finance or a related field; or a minimum of 10 years’ provider contracting experience to include hospital contracting  

       Master’s Degree in Business Administration or Finance a plus

       Proven contract preparation skills, with an in-depth knowledge of Medicare, Commercial, Medicaid, and other reimbursement methodologies and processes 

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