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Medica · 2 months ago

Provider Contracting Manager III

Minnetonka, Minnesota, United States

Full-time

Hybrid

Mid, Senior Level

$77K/yr - $116K/yr

5+ years exp

Medica is a nonprofit health plan that serves communities in multiple states, and they are seeking a Provider Contracting Manager III. This role involves developing and maintaining provider networks, negotiating contracts, and managing provider relationships to ensure a competitive and stable network for their members.

Health CareMedical

No H1B

Responsibilities

Develop and maintain provider networks yielding a competitive, geographic, stable network that achieves objectives for unit cost performance and trend management

Produces an affordable and predictable network for customers and business partners

Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls

Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties

Performs other duties as assigned

Negotiate and draft contracts: Negotiate terms with providers, ensuring they align with Medica's financial goals and standard template agreements

Manage contract renewals and amendments: Track critical dates, manage the renewal process, and handle amendments as needed

Maintain contracts: Keep contractual language and fee schedules up-to-date with current medical policy changes and reimbursement structures

Oversee the entire contract lifecycle: Manage all stages, from initiation and negotiation through execution, monitoring, and closure

Build and maintain relationships: Develop and nurture strong relationships with providers, including high-level representatives of key contracting entities

Resolve issues: Manage provider relations, address issues, and lead dispute resolution processes

Conduct performance assessments: Regularly evaluate the performance of assigned networks and providers to identify areas for improvement

Support network growth: Participate in activities related to network adequacy, provider recruitment, and marketing for providers

Qualification

Contract negotiationProvider contracting knowledgeFinancial analysisHealthcare operations experienceRelationship managementCommunication skillsStrategic thinkingProblem solving

Required

Bachelor's degree or equivalent experience in related field

5 years of work experience beyond degree in contract negotiations and healthcare

Preferred

WI market knowledge preferred

Basic Health plan operations and/or provider operations experience

Excellent communication (written, verbal and presentation) skills

Proven track record of cultivating and maintaining effective, collaborative external relationships where the parties trust information that's conveyed

A proven track record as a successful contract negotiator for health care services, provider or health plan

Flexibility and creativity in developing effective contracting terms

Knowledge of provider contracting components and strategies such as but not limited to risk-based contracting, financial models, operational impact and data analytics

Demonstrated understanding of complex financial arrangements and quality programs across health care products

Strong financial, analytical and problem solving skills, and understanding of legal documents

Strategic-thinking skills with the ability to conceptualize a wide range of scenarios and the ability to analyze each scenario to come up with the most viable option