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Clearlink Partners · 1 day ago

Senior Provider Contractor

United States

Full-time, Contract

Remote

Mid, Senior Level

$90K/yr - $140K/yr

2+ years exp

Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management care populations. The Senior Provider Contractor will oversee provider contracting processes, collaborate with data analysts, negotiate contracts, and monitor network performance to ensure quality outcomes and access.

Health Care

Responsibilities

Oversee completion of required processes for provider contracting to ensure network adequacy

Collaborate with data analysts to extract and present relevant network data

Negotiate provider contract language and terms

Analyze and recommend provider value-based payment and network strategies

Lead the development of access and outcome goals to support contracting strategy

Monitor and review network utilization and financial performance

Evaluate network performance recommending changes to improve access and ensure stability

Provide support for health plan market/ product level operational oversight, management and performance improvement

Leverage industry expertise and knowledge to provide high value consulting and advisory services

Deliver integrated solutions in support of client goals and engagements

Provide delivery assurance support for engagements with assigned clients

Support engagements ensuring completion of contracted services

Create and/ or manage to project plans

Prepare materials for presentation to Client executives

Facilitate and inform key decisions through the use of data and industry best practice sharing

Deliver concise, clear interpersonal communication to both internal and external audiences

Facilitate streamlined exchange of information with engagement manager and client organization partner(s)

Leverage proven methodologies and best practices in support of individual account strategies/ client plans

Establish goals and track progress to ensure achievement

Act in interim leadership capacity to provide supervision and oversight for teams and activities in a direct supervisory model

Identify opportunities to improve workflow, generate accurate, high-quality productivity, support organizational compliance with requirements and deliver reductions in associated costs with improvement in organizational quality performance in collaboration with Client leaders

Develop or update policies and procedures as required to support business needs and requirements

Identify opportunities to streamline and/ or automate workflows

Manage and develop staff to reach established engagement goals, deliverables and KPIs

Adapt processes, approach, plan and/ or activities in real time to ensure critical path activities are achieve

Support account management relationships with key client decision makers

Develop and deploy management reporting, if indicated, to support monitoring and improvement of performance, implementing plans for improvement as necessary

Responsible for ensuring quality, maintaining appropriate resources, competency training and education of staff

Responsible for approving and managing day to day engagement resourcing/ time and attendance as an Engagement Manager

Oversee compliance with internal client related audits, support Client preparation for external audits and surveys

Qualification

Managed care industry knowledgeNegotiating provider contractsProject management principlesHealthcare administration modelsValue-based agreementsCore office software proficiencyManage prioritiesCommunication skills

Required

Experience managing complex work in challenging environments through the alignment of resources and prioritization of efforts to ensure on time, in scope project and/ or strategic delivery

Managed care industry knowledge in operations, costs, requirements, performance and outcomes

Product/ market operational experience in Commercial, Medicare, Medicare Advantage, Medicaid or associated lines of business

Understanding of legal and regulatory frameworks, healthcare administration models, and internal audit procedures

Understanding of key regulations, frameworks, accreditation and oversight bodies to ensure compliance with complex regulatory structures

Knowledge of project management principles, methods, and techniques

Ability to organize, and manage multiple competing priorities

Strong communication skills both written and oral

High proficiency with core office software (Excel, Word, and PowerPoint)

Experience leading Provider relations unit within a managed care environment

Experience negotiating provider contracts and value-based agreements

2+ years progressive experience in managed care at the Manager level or equivalent level, preferably in a government payor environment

Must be able to sit in a chair for extended periods of time

Must be able to speak so that you are able to accurately express ideas by means of the spoken word

Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices

Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse

Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types

Must be able to fluently communicate both verbally and in writing using the English language

Must be able to engage in continuous social interaction, successfully manage stressful high conflict situations, and balance multiple duties, expectations and responsibilities simultaneously