Apply on Employer Site

CareSource · 1 month ago

Director, Contracting(Must Live In Georgia, Contracting & Health Plan Managed Care Experience Required)

United States

Full-time, Contract

Remote

Mid Level

$133K/yr - $233K/yr

3+ years exp

CareSource is a healthcare organization focused on managed care solutions. The Director, Provider Contracting is responsible for executing contracting strategies, developing provisions based on cost and quality analysis, and monitoring key metrics to ensure compliance and effectiveness in provider recruitment and contract administration.

Health CareMedicalNon Profit

Comp. & Benefits

Responsibilities

Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting

Ensure an ongoing high level of staff engagement, empowerment and development

Responsible for provider recruitment, implementation of contracts

Responsible of contracts and testing, initiating set-up, post configuration testing, maintenance and audit of claims system

Create contract language and review with legal to develop approved contract templates

Administer provider contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies

Implement an efficient and effective process to on-board new providers; ensure network is adequate (access for members), cost-effective, competitive and stable, and meets corporate & regulatory requirements

Responsible for ensuring all regulatory requirements for provider network are met

Perform gap analysis to ensure no gaps and/or sanctions occur; identify & implement solutions that mitigate risk; development of corrective action plans as needed

Responsible for access grievance intake, analysis and performance improvement initiatives

Participate in training sessions for providers and staff as appropriate

Support the contracting requirements of the corporation for geographic regions and products

Implement performance improvement initiatives to improve Provider Satisfaction Scores incrementally on an annual basis

Assist with development and review of payment policies and provider notifications

Collaborate with appropriate personnel with process of reassignment of members related to provider terminations, as required by the state

Perform any other job related instruction as requested

Qualification

Contract negotiationManaged care experienceProvider recruitmentMicrosoft Office proficiencyNetwork Management knowledgeTraining skillsEffective communicationCritical thinkingTime management