Provider Services MA

Job Summary:

The Health Partner Network Manager IV acts as the lead negotiator for high value, strategic health partners.

Essential Functions:

• 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

Education and Experience:

• Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is required
• Master’s Degree is preferred
• Minimum of five (5) years of Healthcare experience, to include two (2) years of work experience in provider relations or provider contracting 
• Managed care experience is highly preferred

Competencies, Knowledge and Skills:

• 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

Licensure and Certification:

• 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.  If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated
• 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. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Must be able to perform reasonable travel, up to 30% to fulfill the duties of the position

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business