Compensation: $85,000.00 - $90,000.00

The Regional Contract Manager facilitates development; implementation and management of cost-effective provider networks in his/her assigned geographic region(s). Under the direction of the Manager of Contracting, he/she performs all critical functions necessary to assess, develop, maintain and/or improve provider network adequacy and performance.

Key Functions/Responsibilities: 

  • Gathers and analyzes data and other relevant intelligence in assessing provider network adequacy against required standards and business expectations
  • Identifies, assesses and develops strategies for improving provider and network cost, utilization and quality performance
  • Leads negotiations of financial and other contractual terms in all lines of business
  • Ensures all contract terms and conditions comply with financial and legal requirements of our company and its regulatory entities
  • Develops and maintains business relationships with high-level representatives of key contracting hospitals, physicians and ancillary service providers
  • Participates in the development, implementation & continuous improvement of departmental policies, procedures, workflows, and tools as they relate to network development and provider contracting
  • Performs other duties as required to accomplish departmental and corporate goals & objectives
  • May supervise less experienced staff

Qualifications:

Education: 

  • Bachelor’s Degree in Health Care Administration, Business, related field, or an equivalent combination of education, training and experience is required

Experience: 

  • 3 years of progressive experience in a contracting and analytical capacity in a leadership role is required for individuals with a baccalaureate degree, four years experience is required for individuals without a baccalaureate degree 

Competencies, Skills, and Attributes: 

  • Proven analytical skill in assessing and projecting financial, utilization and quality performance on an individual provider and network basis
  • In-depth knowledge and understanding of contract finance and provider reimbursement methodologies, including risk, shared savings, pay-for-performance and other financial incentive strategies
  • In-depth knowledge and understanding of current healthcare industry issues and trends, including national and state-level payment reform landscape and strategy (e.g., accountable care and patient centered medical home)
  • Proven negotiation skills with hospitals, Integrated Delivery Networks, physicians and ancillary service providers
  • Proven skill in critical thinking and strategic planning and implementation
  • Knowledge of federal and state Medicare, Medicaid, and relevant guidelines, regulations and standards
  • Effective communication (verbal and written) and relationship building skills
  • Expertise in Microsoft Office programs and industry-standard financial applications as appropriate

Must Haves:

Proven negotiation skills with hospitals, Integrated Delivery Networks, physicians and ancillary service providers

Must live in MA or have previous MA health care/insurance experience if in NE

Knowledge of federal and state Medicare, Medicaid, and relevant guidelines, regulations and standards

Senior Product/Skilled Nursing knowledge

Ability to work independently, but also be a team player

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