Manager, Provider Network Optimization
Centene Corporation
full-time
Posted on:
Location Type: Hybrid
Location: Missouri • 🇺🇸 United States
Visit company websiteSalary
💰 $87,700 - $157,800 per year
Job Level
Mid-LevelSenior
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
contract negotiationcontract managementfinancial analysisprovider performance evaluationrate modelingcontract configurationclaims adjudicationnetwork development planningcontracting languagemanaged care principles
Soft skills
leadershipcommunicationnegotiationteam managementorganizational skillsproblem-solvinginterpersonal skillssupervisory skillstrainingperformance management