Contract Manager V

About the role

The individual in this role will be accountable for a high-value healthcare provider network portfolio and unit cost performance for large physician groups, behavioral health providers or facilities including (SUD, IOP, PHP), major healthcare systems which may include a continuum of facilities (acute, long-term, rehabilitation, professional), ambulatory surgery centers, DME providers, etc. Additionally, the individual will need to be able to perform and present findings of qualitative and quantitative analysis around financial and quality metrics for assigned accounts.

Responsibilities

• Promotes learning in others by communicating information and providing advice to drive projects forward; builds relationships with cross-functional stakeholders.
• Counsels on and/or consults with the legal team on complex contract templates and language; responds to inquiries about complex contract templates and language.
• Supports continuous improvement efforts by leveraging innovative and data-driven approaches to identify and/or consult on continuous improvement opportunities across the contract ecosystem.
• Ensures contract commitments are met by validating, maintaining, and/or conducting statistical analyses on provider and contract data of the day-to-week operation and management of services to identify trends and consult on provider compliance.
• Supports contract strategy development by developing, proposing, and implementing short-term strategies that improve access to patient care while managing outside service costs.
• Grows the Provider Network by reviewing or identifying recommended/potential partners/alliances for assigned service area to fill service gaps or decrease costs in current service offerings using advanced knowledge of current service gaps.
• Contributes to provider satisfaction by leveraging specialized knowledge of provider/contract operations to consult on issues that arise from contract configuration/interpretation and/or related to claims/disputes, billing, payment, reimbursement, directories, other operational issues, and/or directories.

Requirements

• Minimum three (3) years of experience in a leadership role with or without direct reports.
• Bachelor's degree from an accredited college or university AND minimum seven (7) years of experience in health care delivery or operations in a managed care environment, customer relationship management, or a directly related field OR Minimum ten (10) years of experience in health care delivery or operations in a managed care environment, customer relationship management, or a directly related field.
• Four (4) years of experience with health care regulatory compliance and filing, contract writing, health care operations, legal research, or insurance/health plan governance experience.
• Project Management Professional (PMP) or equivalent project/program management certification.

Qualifications

• Attention to Detail
• Business Knowledge
• Communication
• Critical Thinking
• Cross-Group Collaboration
• Decision Making
• Dependability
• Diversity, Equity, and Inclusion Support
• Drives Results
• Facilitation Skills
• Health Care Industry
• Influencing Others
• Integrity
• Learning Agility
• Organizational Savvy
• Problem Solving
• Short- and Long-term Learning & Recall
• Teamwork
• Topic-Specific Communication
• Contract Law
• Contract Management
• Applied Data Analysis
• Business Acumen
• Business Planning
• Business Process Improvement
• Business Relationship Management
• Compliance Management
• Computer Literacy
• Consulting
• Health Care Reimbursement
• Interpersonal Skills
• Key Performance Indicators
• Knowledge Management
• Presentation Skills
• Project Management
• Quality Assurance Process
• Time Management
• Training
• Trend Analysis
• Written Communication