Job Description
Job Summary:
The Provider Contract Manager supports the Director, Provider Contracting & Strategic Growth with the development, implementation, and management of provider contracting operations processes.
Essential Functions:
Ensure operational effectiveness by assisting in strategic and business planning, including strategic initiative identification and resource planning and allocation
Partner with leadership to determine and prioritize opportunities to achieve departmental and enterprise goals
Participate in provider contract template development
Provide proactive support, oversight, and management of Preferred, Acceptable, Discouraged, and Unacceptable (PADU). tool and Contract Review Committee (CRC)
Collaborate with internal business areas on contract negotiations to understand and mitigate operational impacts
Act as a provider contract management system subject matter expert including but not limited to facilitating user training, contract template management, system troubleshooting, and business requirements
Facilitate in the development, implementation, and monitoring of departmental policies and procedures
Support activities as assigned in relation to business development
Recognize and proactively manage operational dependencies and risks across strategic initiatives and process improvements
Participate in the process of estimating initiative budgets as well as developing business cases and tracking the benefits realization
Develop and maintain an in-depth knowledge of the company's business and regulatory environments
Perform any other job duties as requested
Education and Experience:
Bachelor's degree in a healthcare related field, or equivalent years of relevant work experience is required
Master's Degree or equivalent work experience is preferred
Minimum of three (3) years of healthcare experience, to include one (1) year of work experience in managed care provider relations or provider contracting
Minimum of three (3) years of experience in leading business initiatives to drive systemic change is preferred
Managed care experience is highly preferred
Competencies, Knowledge and Skills:
Proficient in Microsoft Office Suite (Outlook, Teams, Word, Excel, PowerPoint, and SharePoint). Experience with Visio is a plus
Effective identification of business problems, assessment of proposed solutions to those problems, and understanding of the needs of business partners
Advanced-level knowledge of provider contracting processes and operations
Working knowledge of complex provider organizational structures including but not limited to Accountable Care Organizations (ACOs), Clinically Integrated Networks (CIN), and Independent Practice Associations (IPAs). Excellent written and verbal communication and interaction skills
Effective problem-solving, critical thinking, and listening
Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making
Licensure and Certification:
None
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Perform reasonable travel, up to 15% to fulfill the duties of the position
Compensation Range:
$70,800.00 - $113,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law.
