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CareSource · 6 hours ago

Provider Services MA - R11400

Massachusetts, United States

Full-time

Onsite

Mid, Senior Level

$83K/yr - $133K/yr

5+ years exp

CareSource is a healthcare organization seeking a Health Partner Network Manager IV to lead negotiations with strategic health partners. The role involves executing contracting strategies, managing provider recruitment, and ensuring compliance with regulatory requirements.

Health CareMedicalNon Profit

Comp. & Benefits

H1B Sponsor Likely

Responsibilities

Execute the contracting strategy, develop provisions based on cost, quality/analysis and monitor key metrics for the assigned Market

Lead for identified Market contracting strategic initiatives under the direct supervision of the Market Director or Vice President

Create, execute and administer risk based and value based reimbursement (VBR) strategies as directed by the senior leadership

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

Responsible for provider recruitment, contracting and initiating the loading and credentialing processes

Create contract language and review with legal to develop approved contract templates specific to the assigned Market and within the established corporate guardrails

Analyze financial data and establish rates in collaboration with Provider Contracting leadership and Finance

Negotiate and re-negotiate hospital, ancillary, physician and behavioral health contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies

Market lead for recruitment activities to support new products and product expansion

Support team members through participation in negotiations that support the strategic initiatives

Responsible for complying with all regulatory requirements

Perform gap analysis to ensure no gaps and/or sanctions occur; identify potential providers to recruit that will fill the gaps; identify and implement solutions that mitigate risk; develop corrective action plans as needed

Participate in training sessions for providers and staff as appropriate

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

Knowledgeable of federal and state laws and regulations pertaining to provider contracting

Assist with development and review of payment policies and provider notifications

As requested, become a Subject Matter Expert on specific provider types

Mentor and/or train new hires

Perform any other job duties as requested

Qualification

Provider ContractingHealthcare ExperienceNegotiation SkillsMicrosoft ExcelProvider Network ManagementTraining SkillsOral CommunicationWritten CommunicationTime ManagementCritical Thinking

Required

Bachelor's degree in a healthcare related field, or equivalent years of relevant work experience is required

Minimum of five (5) years of Healthcare experience, to include two (2) years of work experience in provider relations or provider contracting

Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check and verified insurance

To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment

Intermediate proficiency level with Microsoft Outlook Word, and Excel

Knowledge of Provider Network Management Processes & Services

Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making

Strong negotiation skills

Effective oral and written communication skills

Critical listening and thinking skills

Training/teaching skills

Time management skills

Preferred

Master's Degree is preferred

Managed care experience is highly preferred

Benefits

You may qualify for a bonus tied to company and individual performance.

A substantial and comprehensive total rewards package.

Company

CareSource

Glassdoor3.8

CareSource provides managed care services to Medicaid beneficiaries.

Founded in 1989

Dayton, Ohio, USA

1001-5000 employees

https://www.caresource.com/

H1B Sponsorship

CareSource has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (9)

2024 (39)

2023 (35)

2022 (22)

2021 (37)

2020 (28)