Remote with occasional travel (5-10%) 7 years of experience Negotiate competitive managed care agreements with complex providers, including hospital systems, PHOs, and large IPAs. Existing relationships with hospitals in Texas and/or Florida will be helpful

Duties And Responsibilities

• Manages increasingly complex contract negotiations with hospitals and other providers for Commercial product lines (e.g., Hospital systems, Ancillaries, and large physician groups).
• 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

Position Requirements

• 4 year/Bachelor’s degree.
• 7+ years Contracting and Negotiating experience involving complex delivery systems and organizations required
• Experience with Physician, Hospital and Ancillary group contracting and negotiations
• Experience negotiating delegated and capitated agreements
• Experience in developing and managing key provider relationships including senior executives
• Knowledge of complex reimbursement methodologies
• Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
• Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models
• Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization
• The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations
• Customer centric and interpersonal skills are required
• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen