Manager, Provider Network Optimization
Centene Corporation
full-time
Posted on:
Location Type: Hybrid
Location: Missouri • United States
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Salary
💰 $87,700 - $157,800 per year
About the role
- Lead, negotiate, and manage multiple hospital, large medical group, physician, school and/or ancillary contracting activities in accordance with Corporate, health plan, and state guidelines
- Oversee all activities of the contracting department
- Develop and implement a network development plan for an assigned region and set of providers and identify and initiate contact with potential providers
- Negotiate contracts with interested providers utilizing model provider agreements, and follow up on contracts
- Lead negotiations, rate modeling, implementation and ongoing monitoring of assigned group of providers to maximize business relationships and opportunities
- Oversee provider set-up and contract configuration to ensure accurate claims adjudication and facilitate the organization of provider focus groups
- Evaluate and monitor providers’ performance standards and financial performance of contracts
- Ensures compliance with national contracting standards, reimbursement standards, provider set-up rules, exception process and use of model contract language
- Perform financial analyses to identify medical cost improvement opportunities and develop and execute contracting action plans to achieve results
- Performs other duties as assigned
- Complies with all policies and standards
Requirements
- Bachelor’s degree in Healthcare Administration, Business Administration, Marketing, related field or equivalent experience
- 4+ years of provider relations/contracting experience in a healthcare and/or managed care environment
- Working knowledge of contracting language and the principles of negotiation
- Familiarity with managed care, State and/or Federal health care programs
- Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff
- Valid driver's license
- Candidates must be in the state of Michigan to be considered for this role.
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
contract negotiationcontract managementfinancial analysisprovider performance evaluationrate modelingcontract configurationclaims adjudicationnetwork development planningcontracting languagemanaged care principles
Soft Skills
leadershipcommunicationnegotiationteam managementorganizational skillsproblem-solvinginterpersonal skillssupervisory skillstrainingperformance management