Provider Contracts Manager

Negotiate Provider Contracts

Negotiate contract language and rates with hospital, physician, ancillary, and LTSS providers in accordance with established parameters and guidelines.

Collaborate with Compliance, Legal, and Credentialing teams to finalize provider contracts, including amendments and new agreements.

Ensure compliance with regulatory and product requirements related to provider contracting, including network adequacy standards.

Expand Provider Networks

Actively seek opportunities to expand provider networks for existing and new lines of business.

Conduct external meetings with prospective and existing providers to negotiate or renegotiate agreements.

Collaborate with other relevant teams to facilitate network expansion efforts.

Ensure Compliance and Network Adequacy

Assure compliance with regulatory requirements and product specifications related to provider contracting functions.

Monitor and ensure network adequacy, making necessary adjustments to meet regulatory standards.

Coordinate with Network Management, Claims, and Provider Data Integrity teams to ensure accurate contract reimbursement and adherence to requirements.

Contribute to Departmental Goals

Actively contribute to the achievement of departmental goals as outlined in the annual business plan.

Participate in departmental process improvement initiatives to enhance operational efficiency and effectiveness.

Provider Relationship Management

Serve as a liaison between Community Health Choice and its providers, facilitating communication and addressing any issues that arise.

Resolve problems and ensure smooth operations by maintaining positive relationships with providers.

Other Duties

Perform other duties as assigned to support the overall functioning of the department.