Direct Contracting Manager

About the role

Develops and maintains provider relationships within designated state/territory that TriWest is responsible for direct contracting. Manages network development activity with network providers and recruits new providers to meet business needs. Develops hospital, physician and ancillary service agreements, ensures adherence with government operational manuals, monitors network shortfalls, and resolves access issues throughout the assigned region.

Responsibilities

• Provides legendary service and support to maintain strong relationships with internal and external customers.
• Develops negotiation strategies for areas of responsibility to achieve individual and department performance metrics.
• Develops strategic plan to meet network adequacy needs for areas of responsibility and submits to Sr. Manager for inclusion in overall network development plans.
• Regularly reviews and determines appropriate network access and development and makes recommendations to support network build activities.
• Provides regular updates to the Director and/or VP regarding provider network development, management, and access for assigned areas.
• Maintains client confidence and ensures confidential information is protected.
• Works with Provider Services leadership to accurately assess network provider needs within assigned region and establish strategies to achieve them.
• Proactively manages provider networks in assigned areas and functions as primary internal spokesperson on network issues.
• Periodically visits network providers to inform partners about progress towards agreed-upon goals and upcoming network enhancements; coordinates account planning and maintenance issues.
• Provides development and training to Network Providers on changes and updates to TriWest processes and policies.
• Identifies issues for future educational seminars that are identified through provider interactions.
• Collaborates with Provider Education to incorporate these ideas in upcoming provider education materials and updates.
• Assists provider community with any claims issues, including Electronic Media Claim filing problems, reimbursement issues, and billing questions.
• Answer general questions on credentialing process and technical aspects of the Program.
• Makes recommendations to address network shortfalls within region.
• Demonstrate and maintain current knowledge of all programs, contracting, credentialing, reimbursement and operational policies and TriWest initiatives, operations, and goals.
• Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
• Collaborate closely with other department leadership, staff, and executive leadership on process improvement to promote service level improvements or facilitate new processes.

Requirements

Required: Bachelor's degree in Business, Health Care Administration or equivalent experience. Experience managing large or complex provider contracts, 5 years of experience in a Managed Care or equivalent health care environment. Has established relationships and resides in the market for which the position is located. Management experience in the healthcare industry. Experience in utilizing a contract management system to manage contracting workflow. Negotiation experience. Managing Provider Data. Understanding Claims issues and terms. Key Qualifications: Demonstrated ability to develop and maintain provider relationships. Strong negotiation and strategic planning skills. Excellent communication and customer service skills. Proficient in Microsoft Office Suite. Knowledge of Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare, TRICARE, VAPC3). Preferred: Experience in provider contracting for government programs and/or commercial lines of business.

Qualifications

Education: Bachelor's degree in Business, Health Care Administration or equivalent experience. Experience: 5 years of experience in a Managed Care or equivalent health care environment. Management experience in the healthcare industry. Experience in utilizing a contract management system to manage contracting workflow. Negotiation experience. Managing Provider Data. Understanding Claims issues and terms. Key Qualifications: Demonstrated ability to develop and maintain provider relationships. Strong negotiation and strategic planning skills. Excellent communication and customer service skills. Proficient in Microsoft Office Suite. Knowledge of Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare, TRICARE, VAPC3).

Skills

• Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
• Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
• Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.
• Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.
• High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.
• Leadership: Successfully manage provider relationships and lead contract negotiations; takes accountability and follows through on service related requests. Responds with an appropriate sense of urgency.
• Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.
• Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
• Technical Skills: Working knowledge or familiarity with Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare, TRICARE, VAPC3), and the insurance industry; skill in diplomacy and negotiation; skill in financial analysis to analyze contractual reimbursement; skill in project management; skill in presentation; proficient with Excel.

Benefits

Comprehensive and progressive compensation and benefits package that includes: Medical, Dental and Vision Coverage, Paid time off, 401(k) Retirement Savings Plan (with matching), Short-term and long-term disability, basic life, and accidental death and dismemberment insurance, Tuition reimbursement, Paid volunteer time.

Pay

$96,000 to $107,000 per year.

Schedule

Regular and reliable attendance is required.