Network Contractor Provider Network Management

Job Summary

The primary responsibility of the Network Contractor is contracting providers, the contracting and re-contracting of providers in an established market.

Essential Functions

• Supports network development strategy.
• Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication.
• Responsible for negotiating contracts to execute on network strategy and ensure an adequate, compliant and marketable network.
• Responsible for negotiating SCA rates and converting SCA providers to contracted.
• Responsible for recruiting and contracting providers based on identified network adequacy gaps (high complexity).
• Ensures all contracts are negotiated to be compliant with Federal and State rules, regulations, policies and procedures and follow all departmental policies.
• Ensures contracts are supportive of Plan quality initiatives such as HEDIS, CAHPS and NCQA/URAC.
• Negotiates contracts to support management of provider satisfaction.
• Works with CPNM to manage the annual contracting schedule as well as supplement the network as new providers are available or needed.
• Reviews contract language and collaborates with legal to ensure best contract terms.
• Supports contracting for multiple product lines, including LTSS, Exchange, DSNP.
• Lead negotiator of VBC in conjunction with AE.

Education/Experience

• Bachelor's Degree.
• Five or more years’ experience if no Bachelor’s Degree.
• Three or more years AE experience, Financial Acumen, Ability to have difficult conversations, 1+ year contract negotiation experience, Understanding of reimbursement methodologies to include risk or VB contracting.

Work Arrangement

This position is a remote field based position. Must reside in South Carolina. Will make provider visits throughout the state.

Benefits

Comprehensive benefits package including flexible work solutions, competitive pay, paid time off, health insurance coverage, 401(k), tuition reimbursement, and more.