Provider Network Contractor II

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees.

About the role

Develop and maintain provider networks yielding a competitive, geographic, stable network that achieves objectives for unit cost performance and trend management. Produces an affordable and predictable network for customers and business partners. Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties. Performs other duties as assigned.

Responsibilities

• Develop and maintain provider network yielding a competitive, geographic, stable network that achieves objectives for performance and growth.
• Evaluates and negotiates contracts in compliance with company contract templates and reimbursement structure standards.
• Builds and maintains positive relationships with providers.
• Processes and negotiates needed provider contract amendments and assignments as requested; and communicates contract terms and provisions to provider and all needed internal staff.
• Updates and maintains contract tracking system, records information sharing system and contracting calendar within contract metric timeframes.

Requirements

• Bachelor's degree or equivalent experience in healthcare management/administration or healthcare related field
• Plus 3 years of work experience in health insurance/healthcare field

Skills

• Strong knowledge of managed care products, e.g. HMO, POS, PPO and provider network administration
• Health plan negotiation experience preferred
• Expertise working with Microsoft Word, Excel, and Outlook
• Strong verbal and written communication
• High level of attention to detail and customer service
• Maintain regularly assigned work schedule

Schedule

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, St. Louis, MO, or Omaha, NE.

Pay

The full salary grade for this position is $70,200 - $120,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $70,200 - $105,315. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary.

Benefits

Medica offers a generous total rewards package that includes:

• Competitive medical, dental, and vision coverage
• Paid time off (PTO) and holidays
• Paid volunteer time off
• 401K contributions
• Caregiver services and many other benefits to support our employees

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.