Manager Regional Contracting

Job Description:

Summary:

This position is responsible to negotiate, plan, direct and control activities related to provider contracting, including but not limited to facility, professional, ancillary, and value-based arrangements. Ensures that the Company acts as prudent purchasers of services by developing, maintaining, and enhancing contractual and payment relationships with all assigned providers. The Regional Contractor effectively analyzes contracting needs; develops, recommends and executes approved strategy, tactics, concessions and adjustments; manages issue resolution and process improvement opportunities; and monitors contract implementation and compliance. The Regional Contractor may be assigned overall responsibility to finalize contracts under their assigned area within an established budget and with guidance from assigned management. This role coordinates across a highly matrixed environment of internal and external stakeholders, facilitating engagement and decisions, and ensuring robust communication. The Regional Contractor may assist in incentive payment design, program development, and project coordination as assigned.

Essential Accountabilities:

· Maintains and enhances a strong relationship with providers, while balancing the need to maintain competitive pricing position through effective negotiations. Develops and maintains critical knowledge and information regarding providers, region & industry that may be used to set contracting budget and strategy plan.

· As assigned, evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. May be delegated authority to act and speak on behalf of the company within assigned parameters.

· Analyzes and anticipates network and contracting needs within assigned areas of responsibility. Recommends contracting solutions and strategies to management.

· Implements approved contracting strategies and tactics. Effectively secures desired contract terms.

· Develops, maintains and communicates contracting roadmaps including line of business, DOH and CMS strategies and requirements.

· Assists in development and maintenance of legal contract templates and amendments and obtains appropriate and timely signoff from internal legal, line of business and risk management areas.

· Provides clear feedback to provider relations and other stakeholders to ensure effectiveness in addressing provider issues and needs, and contract compliance.

· Works collaboratively with colleague departments to develop provider budget models, ensure accurate and timely configuration of rate updates, and ensure appropriate strategies are developed and implemented relative to benefit expense management and Health Plan strategy.

· May assist in incentive payment design, lead program development and/or coordinate other projects, as assigned.

· Develops and maintains appropriate documentation, including status, workplans, and other communication and reporting tools.

· Must develop and maintain a current and thorough understanding of healthcare, financial models, physician organizations, contracts, and the Corporations’ products, and must be able to effectively discuss these issues with others.

· Presents an effective and positive image of the Health Plan and its leadership by promoting Health Plan’s community initiatives and not for profit goals.

· Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.

· Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

· Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are compliant with these requirements.

· Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.

· Regular and reliable attendance is expected and required.

· Performs other functions as assigned by management.

Minimum Qualifications:

· Bachelor’s degree in Health Care Administration, Finance, Public Administration or relevant field required. In lieu of degree, five years of related experience is required.

· Three - five years’ experience involved in reimbursement, finance, contract negotiations, or related experience with hospitals and providers. Experience in finance, actuarial, and provider relations is preferred.

· Two years’ leadership/management experience required.

· Excellent communication, presentation, problem solving and negotiation skills.

· Must be able to work constructively with external contacts including hospital administrators, owners of provider companies, physicians, provider organization leaders, and other providers of health and health related services and equipment.

· Demonstrated understanding of current industry trends including healthcare operations, insurance products, and provider entities. Experience with reimbursement methodologies (private and governmental) and ability to understand and utilize financial models. Able to knowledgably and effectively discuss these issues with others.

· In depth knowledge of regional provider networks and relationships.

· Ability to maintain composure and professionalism during high stress and contentious situations.

· Knowledge of CMS and NYS pricing methodologies and regulations.

· Knowledge of medical management programs and their impact upon providers and members as well as impact on contract compliance.

· Knowledgeable of Health Plan’s strategies and initiatives and able to articulate those appropriate to providers.

· Knowledgeable of Blue Cross Blue Shield Association strategies and initiatives and able to articulate those appropriate to providers.

Physical Requirements:

· Ability to travel across health plan region(s) for meetings and events. Primarily same-day travel; some overnight travel may be required.

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In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Grade E7: Minimum $87,766 - Maximum $157,978

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: The opportunity for remote work may be possible for all jobs posted by the Univera Healthcare Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.