Existing relationships with physician groups in Texas and/or Florida will be helpful

7+ years of experience with health plan or provider organizations


  • Manages contract negotiations with large physician groups and ancillary providers; conducting several negotiations simultaneously to meet growth demands  

  • Deep understanding and experience with all clinical specialties to ensure contract terms and conditions address the coding structures which are most impacted by negotiations

  • 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

  • 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; including renegotiation of existing agreements

  • Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms

  • Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities.

  • Assists in resolving elevated provider service complaints; researching and negotiating with internal/external partners/customers to resolve complex and/or escalated issues.

  • Manages key provider relationships and is accountable for critical interface with providers and business staff

  • Coach and support new team members on negotiation strategies and approaches to successful 

  • 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; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity


Position Requirements

  • Bachelor’s degree or equivalent experience in related field, including 7+ years of work experience beyond degree within provider contracting and/or health insurance

  • Superior problem solving, decision-making, negotiating skills, contract language and financial acumen

  • Experience with Physician group and ancillary provider contracting and negotiations

  • Experience negotiating delegated credentialing agreements

  • Experience in developing and managing key provider relationships including senior executives

  • 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 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

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