Clearlink Partners · 7 hours ago
Senior Provider Contractor
United States
Full-time, Contract
Remote
Mid, Senior Level
$90K/yr - $140K/yr
2+ years expClearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management care populations. The Senior Provider Contractor will supervise day-to-day work production, ensure compliance with state and contractual requirements, and lead negotiations for provider contracts while collaborating with data analysts to support network adequacy and performance.
Health Care
Responsibilities
Supervise day-to-day work production, queue management and work quality for assigned team
Produce necessary tracking, trending and reporting for staff management
Monitor and ensure team compliance with state and contractual requirements
Monitor and ensure team compliance with Client standards, policies, procedures and workflows
Orient and train oncoming staff with progress updates to Manager
Perform daily audits to monitor learning and ability to work independently
Educate and train staff to ensure compliance and Client alignment
Maintain and update team training documents as needed
Ensure appropriate use of resources and job aides to facilitate streamlined delivery
Perform regular staff audits based on client and internal audit parameters (monthly minimum)
Provide coaching and remediation for corrections
Coordinate findings (trends, individual and team) for communication to Client
Finalize for inclusion into files for performance management discussions
Conduct team meetings as needed
Provide updates, review processes, provide education to assigned teams
Establish and monitor daily group chat with the associated teams
Provide direction to manage work queues, ensuring compliance with requirements (TAT, etc.)
Communicate as directed with supporting Client supervisors and managers
Provide ongoing updates to Engagement Manager on production and quality
First line of communication for staff related to unresolved Clearlink and/or Client IT issues and challenges
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
Required
Strong understanding of associated managed care workflow(s) industry standards and best practice with ability to seek innovate methods and incorporate them into existing practice to improve team performance
Ability to train, inform, advocate, promote and facilitate health care options, and demonstrated ability to problem solve, track and motivate team performance
Strong computer skills and knowledge of various managed care platforms and solutions
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 with North Carolina market
Experience leading Provider relations unit within a managed care environment
Experience negotiating provider contracts and value-based agreements
Bachelor's Degree preferred, will accept equivalent experience in managed care environment
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
Preferred
Visio skills preferred
Company
Clearlink Partners
Clearlink Partners is a Total Cost of Care (“TCOC”) and operational efficiency consulting firm.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
James Dandy
SVP, Chief Administrative Officer
Recent News
2025-08-14
2025-04-16
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