Contract Manager-NH

Job Summary

The Contract Manager facilitates development; implementation and management of new and current cost-effective provider networks for multiple products. He/she performs all critical functions necessary to assess, develop, maintain and/or improve provider network adequacy and performance including leading NH product expansion, recruitment and contracting efforts.

Key Functions/Responsibilities

• Affords provider partners in the interpretation of data tools and analytics provided by the Plan, including Alternative Payment Arrangements (APMs) and Quality Incentive Programs (QIPs) reporting and other incentive programs developed.
• Ensures the contracting and implementation process is administered appropriately and ensures integrity of data. Ensures materials used with providers are accurate and appropriate for the given situation.
• Demonstrates knowledge of varying payment methodologies including but not limited to DRG, Capitation, APMs, Fee-for-Service, Per Diem, Per Case and Percent of Charges.
• Supports strategic network composition and design initiatives, consistent with the objectives of Well Sense.
• Led and managed all aspects of provider implementation to ensure provider hierarchy and data are loaded appropriately in all relevant systems. This includes understanding and communicating unique arrangements and ensuring the Plan accurately administers those arrangements.
• Ensures provider compliance with contractual, regulatory and NCQA requirements and standards.
• Participates in cross-functional workgroups as requested.
• Gathers and analyzes data and other relevant intelligence in assessing provider network adequacy against required standards and business expectations;
• Identifies, assesses and develops strategies for improving provider and network cost, utilization and quality performance;
• Leads negotiations of financial and other contractual terms in all lines of business;
• Ensures all contract terms and conditions comply with financial and legal requirements of Well Sense and its regulatory entities (e.g., NH DHHS, Medicare, DOI etc);
• Develops and maintains business relationships with high-level representatives of key contracting hospitals, physicians and ancillary service providers;
• Participates in the development, implementation & continuous improvement of departmental policies, procedures, workflows, and tools as they relate to network development and provider contracting;
• Performs other duties as required to accomplish departmental and corporate goals & objectives.

Qualifications

• Education: Bachelor’s Degree in Health Care Administration, Business, related field, or an equivalent combination of education, training and experience is required.
• Experience: 3 years of progressive experience in a contracting and analytical capacity in a leadership role is required for individuals with a baccalaureate degree, four years experience is required for individuals without a baccalaureate degree.

Compensation Range

$77,000 - $112,000

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Note

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note

This range is based on Boston-area data, and is subject to modification based on geographic location.