Manager, Contract Negotiator
Position Purpose: Join Carolina Complete Health Network in building an organization in which our team exceeds ourstakeholders’ expectations and our Pay for Performance model will reward team members who continuously do so.
Reporting to the Senior Director, Network Development, the Manager, Contract Negotiator coordinates and negotiates hospital, physician (IPAs, PPMs, individual providers, multi-specialty groups) and ancillary service agreements that are in accordance with Carolina Complete Health Network, Carolina Complete Health, and State guidelines.
Develops healthcare provider network plan for region and set of providers.
Identifies, negotiates, and manages complex contractual arrangements with providers.
Leads assigned negotiations (i.e., hospital, physician, ambulatory surgical centers, and ancillary) and ensures that negotiations result in the unit cost targets expected and meet the objectives of Carolina Complete Health Network.
Develops and maintains relationships with physician and business leadership of key physician groups, hospitals, and integrated delivery systems.
Facilitates and provides oversight to the provider set-up and contract configuration to ensure accurate claims adjudication and adherence to legal and regulatory standards prior to execution.
Evaluates and monitors providers’ performance standards and financial performance of contracts, renegotiates where applicable and applies managed care reimbursement principles (value-based initiatives, capitation, case rates, creative reimbursement, etc.) to maximize cost savings.
Identifies medical cost improvement opportunities.
Assists with and tracks credentialing activities.
Facilitates the organization of provider focus groups.
Coordinates with internal departments and contracted healthcare providers to implement and maintain contract compliance.
Participates in organizational audits to ensure organizational compliance with regulatory agencies as appropriate.
May require up to 25% travel
Bachelor’s degree in Healthcare Administration, Business Administration, Marketing, related field, or equivalentexperience.
5+ years of contracting, provider relations or other related experience preferably in a healthcare, managed care, or insurance related environment.
Excellent written, oral, and presentation skills.
Ability to work collaboratively with staff and contractors at all levels.
Well developed organizational skills and attention to detail.
High proficiency with Microsoft Office products, as well as communication productivity tools.
Carolina Complete Health Network is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristics protected by applicable law.