Duties And Responsibilities

• Manages complex contract negotiations with large and/or complex providers for commercial product lines (e.g., Ancillaries, large physician groups, some smaller hospitals).
• Proactively builds relationships that nurture provider partnerships to support the local market strategy.
• 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.
• 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.
• Partner with Regulatory Affairs to ensure all network filings are timely and accurate.
• Initiates, nurtures and maintains effective channels of communication with internal matrix partners including but not limited to Claims, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing.

 

Requirements

•  Bachelor’s degree or equivalent experience in related field, plus 7+ years of work experience beyond degree within provider contracting and/or health insurance
• At least 7 years of relevant managed care contracting experience; specifically focused on Texas
  hospital relationships and negotiations
• 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
• Team player with proven ability to develop strong working relationships within a fast-paced organization
• Nimble to pivot to different strategies, projects and priorities quickly
• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen