Duties And Responsibilities

• Manages complex contract negotiations with physician groups and facilities commercial product lines (e.g., Ancillaries, large physician groups, some smaller hospitals).
• Proactively builds relationships that nurture provider partnerships to support the local market strategy.
• Initiates, nurtures and maintains effective channels of communication with matrix partners including but not limited to, Claims, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing.
• Supports and provides direction to develop network analytics required for the network solution.
• Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position.
• Identify and manages initiatives that improve total medical cost and quality.
• Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.
• Assists in resolving elevated and complex provider service complaints. Research problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.
• Manages key provider relationships and is accountable for critical interface with providers and business staff.
• Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
• Partner with Regulatory Affairs to ensure all network filings are timely and accurate.
• Performs other duties as assigned

Position Requirements

• Bachelor’s degree or equivalent experience in related field, plus 5+ years of work
• 5-7 years of experience Negotiate competitive managed care agreements with complex providers, including hospital systems, PHOs, and large IPAs.
  
• Experience beyond degree within provider contracting and/or health insurance
• Experience with Physician and Ancillary group contracting and negotiations
• Experience negotiating delegated credentialing agreements
• Experience in developing and managing key provider relationships including senior executives
• Existing relationships with hospitals or large physician groups in Texas and/or Florida will be helpful