Job Summary:
The Manager, HP Contracting & Service is responsible for the execution of the contracting strategy, develop provision based on cost, quality/analyst and monitor key metrics for the Market.
Essential Functions:
- Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting
- Ensure an ongoing high level of staff engagement, empowerment and development
- Responsible for provider recruitment and implementation of contracts
- Responsible for contracts and testing, initiating set-up, post configuration testing, maintenance and audit of claims system
- Create contract language and review with legal to develop approved contract templates specific to the Market and within the established corporate guardrails
- Administer provider contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
- Implement an efficient and effective process to on-board new providers; ensure network is adequate (access for members), cost-effective, competitive and stable, and meets corporate & regulatory requirements
- Responsible for ensuring all regulatory requirements for provider network are met
- Perform gap analysis to ensure no gaps and/or sanctions occur; identify & implement solutions that mitigate risk; development of corrective action plans as needed
- Coordinate the account strategy and provide account support with the goal of driving the overall satisfaction and engagement of Health Partner network
- Resolve routine issues with the Health Partners in the market in accordance with the department’s service level agreements/expectations
- Coordinate the PR Customer Relationship Management (CRM) tool and assignment of tasks for the Health Partner Consultant when appropriate
- Responsible for grievance intake, analysis and performance improvement initiatives
- Participate in training sessions for providers and staff as appropriate
- Support the contracting requirements of the corporation for geographic regions and products
- Assist with development and review of payment policies and provider notifications
- Perform any other job related instruction 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 three (3) years of contract negotiation experience is required
- Minimum three (3) years of management experience is required
- Managed care experience is highly preferred
Competencies, Knowledge and Skills:
- Intermediate proficiency level with Microsoft Outlook Word, and Excel
- Knowledge of Network Management Processes & Services
- Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making
- Effective oral and written communication skills
- Critical listening and thinking skills
- Training/teaching skills
- Time management skills
Licensure and Certification:
- Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated
- To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
- CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
Working Conditions:
- General office setting, noise level is generally quiet to moderate
- Perform reasonable travel, up to 50% to fulfill the duties of the position
Compensation Range:
$79,800.00 - $127,600.00
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. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
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, including disability and veteran status. We are committed to a diverse and inclusive work environment.