Contract Manager - Provider Network Relevant Educational Qualifications Job3 months ago - Other categories - Tempe - 19 views
Contract Managers are key part of the ongoing management of the CareCentrix provider network and are involved in contracting activities and managing network providers for multiple payers. In this role, you will prepare, analyze, negotiate and maintain contracts for the provider network for the services that CareCentrix provides on behalf of its clients. You will be responsible for the development/fostering of relationships with providers and colleagues to ensure high levels of client interaction and satisfaction. You will also be responsible for participating in the development of the network management strategy which includes aspects of technology product, utilization management, value-based care, membership growth, marketing, compliance, and member and provider experience.
In this role, you will:
- Assist in facilitating provider meetings and forums as appropriate or per compliance and contractual guidelines.
- Partner with departments including claims and UM teams to address, resolve and communicate operational issues raised by providers
- Coordinate with relevant internal stakeholders across various departments to ensure contract aligns with operational processes
- Identify alternative providers who can service patients when transitioning from one provider to another when a contract termination occurs
- Execute processes required for new providers to join the network
- Identify areas for improvement within the contracts based on Senior Contract Manager oversight
- Track the overall performance of their contracts, collaborating with the various business offices regarding administrative issues and facilitating the resolution of any payment or contract compliance issues.
- Manage the negotiation or renegotiation of contracts as appropriate within designated state(s) or region
- Ensure that the contracts, including fee schedules are complete, accurate and timely
- Negotiate a large portion of CareCentrix provider & managed care contracts to achieve strategic contracting goals with a variety of health plans, payers and products (DME, Sleep, Home Infusion, Home Health, PAC, Hospice)
- Prioritize and negotiate better rates with out of network providers
- Be the external face of CareCentrix to the providers assigned to you
- Develop deeper partnerships with key target providers in the region
- Present CareCentrix to hospitals, health plans, physicians, ambulatory surgery centers, home health and other professional services and understand the services provided by each
- Work with providers to develop contract strategies to improve coverage with high quality, cost efficient providers that service our health plan members timely
- Meet with providers in person and/or virtually as needed
Why You Are Going to Love this Role and CareCentrix:
- You love negotiations that result in a win-win for both parties.
- You are passionate about fixing health care and believe that one of the best ways to do that is by helping improve the quality and access to care in the home.
- You enjoy getting your hands dirty in operational weeds to help your customers address their needs.
- You enjoy working with teams by building trust, fostering positive relationships and partnering with a diverse group of people.
You should get in touch if:
- You have a Bachelor's degree desired or minimum of 4 years experience in managed care contracting experience will be considered in lieu of degree.
- You understand financial analysis and can derive written summaries from data.
- You have the ability to present in front of a group
- You have proficiency in Microsoft Office, including Excel, PowerPoint with advanced knowledge of computer systems and database development and management
- You have proven track record in negotiations and leading meetings, creating agendas and achieving goals.
- You are able to track, edit and monitor complex contracts with multiple language changes and a series of addenda.
CareCentrix maintains a drug-free workplace.
We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.