Manager, Provider Network Contracting

Primary Responsibilities

• Manage unit cost budgets, target setting, performance reporting, and associated financial and network pricing models
• Lead the development of geographically competitive, broad-access, and stable provider networks that achieve unit cost and medical trend objectives
• Evaluate and negotiate provider contracts in compliance with company templates, reimbursement standards, and established process controls
• Ensure network composition includes an appropriate distribution of provider specialties across markets
• Influence and contribute to forecasting, planning, and strategic decision-making activities
• Establish and maintain strong business relationships with hospitals, physicians, pharmacies, ancillary providers, and large medical groups
• Partner with senior leaders across lines of business to support network strategy and performance
• Set team direction, resolve complex issues, and provide coaching, guidance, and performance management for direct reports

Leadership & Scope

• Manages and is accountable for professional employees and/or supervisors
• Impact of work is primarily at the local or market level

Required Qualifications

• 5+ years of experience in a network management or related role managing complex provider networks with accountability for business results
• 3+ years of experience in provider contracting
• 2+ years of experience with financial modeling, and medical cost and administrative budget management
• 2+ years of people leadership or supervisory experience
• Expert-level knowledge of Medicare reimbursement methodologies, including RBRVS, DRGs, Ambulatory Surgery Center Groupers, and related payment models
• Driver's License and access to a reliable transportation

Pay

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Benefits

Our mission of helping people live healthier lives extends to our team members. Learn more about our range of benefits designed to help you live well.