[Hiring] Health Partner Network Manager @CareSource

Role Description

The Health Partner Network Manager executes the Health Partner contracting strategy, develops contract provisions based on cost, quality/analysis and monitors key metrics for the assigned Market.

• Create, execute and administer value based reimbursement (VBR) strategies as directed.
• Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting initiatives.
• Responsible for provider recruitment, contracting and initiating the loading and credentialing processes.
• Responsible for following up / auditing providers as they proceed through the loading process to ensure accuracy.
• Create contract language and review with legal to develop approved contract templates specific to the assigned Market and within the established corporate guardrails.
• Analyze financial data and establish rates in collaboration with Provider Contracting leadership and Finance.
• Negotiate and re-negotiate hospital, ancillary, physician and behavioral health contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies.
• Build networks to support new products within the market and on-board new providers.
• Responsible for complying with all regulatory requirements.
• Perform gap analysis to ensure no gaps and/or sanctions occur; identify potential providers to recruit that will fill the gaps; identify and implement solutions that mitigate risk; develop corrective action plans as needed.
• Participate in training sessions for providers and staff as appropriate.
• Support the contracting requirements of the corporation for geographic regions and products.
• Knowledgeable of federal and state laws and regulations pertaining to provider contracting.
• Assist with development and review of payment policies and provider notifications.
• As requested, become a Subject Matter Expert on specific provider types.
• Mentor junior contractors, as requested.
• Perform any other job duties as requested.

Qualifications

• Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is required.
• Master’s Degree is preferred.
• Minimum of three (3) years of Healthcare experience, to include one (1) year of work experience in managed care provider relations or provider contracting.
• Managed care experience is highly preferred.

Requirements

• Intermediate proficiency level with Microsoft Outlook Word, and Excel.
• Knowledge of Provider Network Management Processes & Services.
• Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making.
• Strong negotiation skills.
• Effective oral and written communication skills.
• Critical listening and thinking skills.
• Training/teaching skills.
• Time management skills.
• Must have valid driver’s license, vehicle and verifiable insurance.
• Influenza vaccination is a requirement of this position.

Benefits

• Compensation Range: $72,200.00 - $115,500.00.
• In addition to base compensation, you may qualify for a bonus tied to company and individual performance.
• Substantial and comprehensive total rewards package.

Working Conditions

• General office environment; may be required to sit or stand for extended periods of time.
• Perform reasonable travel, up to 30% to fulfill the duties of the position.

Organization Level Competencies

• Fostering a Collaborative Workplace Culture.
• Cultivate Partnerships.
• Develop Self and Others.
• Drive Execution.
• Influence Others.
• Pursue Personal Excellence.
• Understand the Business.

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.