WellSense Health Plan · 1 day ago

Contract Manager, BH Network Strategy

Boston, MA

Contract

Remote

Mid Level

3+ years exp

Maximize your interview chances

Hospitals and Health Care

Insider Connection @WellSense Health Plan

Discover valuable connections within the company who might provide insights and potential referrals.
Get 3x more responses when you reach out via email instead of LinkedIn.

Responsibilities

Lead negotiations of financial and other contractual terms for behavioral health agreements for the Medicare, Medicaid and Commercial suite of products

Ensure all contract terms and conditions are in compliance with financial, legal and regulatory requirements and align with company goals

Gather and analyze data and other relevant intelligence in assessing provider network adequacy against required standards and business expectations

Monitor and evaluate provider performance using key identified metrics to ensure compliance with contractual terms and improved outcomes

Identify, assesses and develops strategies for improving provider and network cost, utilization and quality performance

Develop and maintain effective external relationships with high-level representatives of participating provider organizations and acts as the primary contact for these providers

Develops and maintains effective relationships with cross functional teams including WellSense Legal, Compliance, Public Partnership, Network Operations, Behavioral Health Strategy, Provider Relations and all other applicable departments to advance the highest quality behavioral health network

Participates in the development, implementation & continuous process improvement of departmental policies, procedures, workflows to support a high performing network

Other duties and projects as assigned

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Health Care AdministrationHealth Insurance ContractingBehavioral Health ServicesData AnalysisPower PointExcelWordMicrosoft TeamsSharepointPresentation SkillsRelationship ManagementProcess Improvement

Required

Bachelor’s Degree in Health Care Administration, Business, related field, or an equivalent combination of education, training and experience is required.

3 years of experience in a health insurance contracting and analytical capacity

Advanced knowledge of behavioral health services and insurance market

Effective internal and external presentation development and skills

Comfortable working in a complex matrix environment

Proficient in Power Point, Excel, and Word

Experience with Microsoft Teams and Sharepoint

Pre-employment background check