Health Plan Provider Contracts Manager - Complex

About the role

This position provides expertise and leadership in complex health plan provider network contracting, focusing on network development, financial, and operational performance.

Responsibilities

• Negotiating agreements with strategic provider groups such as hospitals, physician groups, and behavioral health organizations, emphasizing value-based payment models.
• Managing contract execution, analyzing financial impacts, and supporting network adequacy and compliance with regulatory standards.
• Developing provider relationships, recruiting providers, and engaging in renegotiations to control costs and improve network quality.
• Communicating contract terms and reimbursement structures clearly to providers.
• Participating in fee schedule and reimbursement model development.
• Collaborating with internal teams and leadership on strategic initiatives.
• Mentoring team members and supporting special projects.
• Traveling throughout the state as needed.

Qualifications

• Minimum 5 years of experience in network contracting with large provider groups, including negotiations in managed healthcare settings.
• Familiarity with various payment methodologies such as value-based payment, fee-for-service (FFS), and capitation.

Skills

• Strong negotiation, relationship-building, and regulatory navigation skills.
• Data-driven decision-making, analytical capabilities, organizational skills, and attention to detail.
• Effective communication skills and proficiency in Microsoft Office and contract management software.
• Ability to work cross-functionally and manage multiple tasks simultaneously.

Preferred Skills

• Experience with integrated delivery systems, hospitals, and specialty groups.
• Knowledge of Medicaid, Medicare, and government-sponsored programs.