About the role

  • Responsibility over MA National Risk partnerships, including CareAllies, encompassing contracting, partner retention, operations, growth, financial and quality performance and strategic planning.
  • Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management.
  • Coordinate contracting with staff who may report directly to other Directors and Managers within Network Management, as needed.
  • Oversee the analysis and reporting required to develop reimbursement strategies and take corrective action as needed
  • Oversee the performance of negotiated health care provider compensation and appropriate reimbursement of medical costs
  • Analyze monthly activity reports, budget and variance reports and formulate resolutions for problem trends.
  • Identify deficiencies in reporting capabilities and coordinate development and implementation of needed methodologies.
  • Develop, implement and maintain processes and standards for provider network expansion, contracting and servicing. Ensure that quality standards regarding the provider network are met.
  • Directly manage staff including but not limited to: hiring, performance management, talent management, training, counseling, pay administration and change management.
  • Assist in presentations to existing and potential customers.

Requirements

  • Bachelor’s degree plus 5 years’ experience in hospital/health care contracting, and hospital/physician relations
  • 5 years management experience
  • Experience working with large integrated health care delivery systems and complex reimbursement strategies
  • Experience proactively developing and maintaining relationships with health care provider leadership teams with propensity to build trust
  • Knowledge of outpatient and provider reimbursement strategies and policies
  • Experience with financial matters such as contract performance and impact including accuracy and sound judgment
  • Experience proactively developing creative, win-win solutions considering the impact on the provider contract, network, marketability of the product, and profitability of the product
  • Negotiation skills
  • Leadership skills
  • Team player/relationship oriented
  • Clear and concise verbal and written communications skills including interpersonal skills, presentation skills to present to executives internally and externally, and team building
  • Experience meeting deadlines and work well under pressure
  • Experience working across departments to accomplish initiatives and goals, building consensus, driving initiatives, gaining support and developing workable solutions
  • Ability and willingness to travel, including overnight stays
  • Overseeing the annual budget and allocating resources for various projects and operational needs.
  • Translating needs and initiatives into compelling business cases.
  • Conducting cost-benefit analyses to justify investments and ensure ROI.

Benefits

  • health and wellness benefits
  • 401(k) savings plan
  • pension plan
  • paid time off
  • paid parental leave
  • disability insurance
  • supplemental life insurance
  • employee assistance program
  • paid holidays
  • tuition reimbursement
  • other incentives

Job title

Director, Provider Contracting

Job type

Experience level

Lead

Salary

$118,800 - $220,800 per year

Degree requirement

Bachelor's Degree

Location requirements

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