Health Partner Network Manager

About the role

The Health Partner Network Manager executes the Health Partner contracting strategy, develops contract provisions based on cost, quality/analysis and monitors key metrics for the assigned Market.

Responsibilities

• Create, execute and administer value based reimbursement (VBR) strategies as directed
• 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
• Responsible for following up / auditing providers as they proceed through the loading process to ensure accuracy
• 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
• Build networks to support new products within the market and on-board new providers
• 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 junior contractors, as requested
• Perform any other job duties as requested

Requirements

Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is required; Master’s Degree