Direct Contracting Manager

TriWest Healthcare Alliance Corp.; Phoenix (AZ); Remote; USD 87,000 - 102,000; Full time

Benefits offered by this job

Medical, Dental and Vision Coverage

Paid time off

401(k) Retirement Savings Plan (with 9

Short-term and long-term disability

Life insurance

Job summary

TriWest Healthcare Alliance is seeking a seasoned professional to develop and maintain provider relationships within designated regions and to drive network development in alignment with DoD program requirements.

The role emphasizes negotiation, contract management, and strategic planning to ensure network adequacy and high-quality provider access. DoD background and citizenship are required; remote opportunities exist within the United States.

Qualifications

• Bachelor's degree in Business, Health Care Administration or equivalent experience.
• Experience managing large or complex provider contracts.
• 5 years of experience in a Managed Care or equivalent health care environment.

Responsibilities

• Provides legendary service and support to maintain strong relationships with internal and external customers.
• Develops negotiation strategies for areas of responsibility to achieve individual and department performance metrics.
• Develops strategic plan to meet network adequacy needs for areas of responsibility and submits to Sr. Manager for inclusion in overall network development plans.
• Regularly reviews and determines appropriate network access and development and makes recommendations to support network build activities.
• Monitors and resolves routine and escalated provider issues.
• Communicates information regarding market needs, competition, and industry trends to management team.

Skills

Negotiation

Provider contracting

Relationship management

Leadership

Strategic planning

Communication

Education

Bachelor's degree in Business, Health Care Administration or equivalent experience

5 years of experience in a Managed Care or equivalent health care environment

Tools

Excel

Contract management system

Job description

• Negotiation experience

Profile

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary

Develops and maintains provider relationships within designated state/territory that TriWest is responsible for direct contracting. Manages network development activity with network providers and recruits new providers to meet business needs. Develops hospital, physician and ancillary service agreements, ensures adherence with government operational manuals, monitors network shortfalls, and resolves access issues throughout the assigned region. Facilitates resolution of escalated provider issues, and promotes TriWest Corporate initiatives.

Education & Experience

Required:

• Bachelor's degree in Business, Health Care Administration or equivalent experience
• Experience managing large or complex provider contracts
• 5 years of experience in a Managed Care or equivalent health care environment

Preferred

• Experience in provider contracting for government programs and/or commercial lines of business
• Has established relationships and resides in the market for which the position is located.
• Management experience in the healthcare industry
• Experience in utilizing a contract management system to manage contracting workflow
• Negotiation experience
• Managing Provider Data
• Understanding Claims issues and terms

Key Responsibilities

• Provides legendary service and support to maintain strong relationships with internal and external customers.
• Develops negotiation strategies for areas of responsibility to achieve individual and department performance metrics.
• Develops strategic plan to meet network adequacy needs for areas of responsibility and submits to Sr. Manager for inclusion in overall network development plans.
• Regularly reviews and determines appropriate network access and development and makes recommendations to support network build activities.
• Provides regular updates to the Director and/or VP regarding provider network development, management, and access for assigned areas.
• Monitors and ensures resolution of routine and escalated provider issues.
• Communicates information regarding market needs, competition, and industry trends to management team.
• Provides training and development to team members.
• Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
• Maintains client confidence and ensures confidential information is protected.
• Works with Provider Services leadership to accurately assess network provider needs within assigned region and establish strategies to achieve them.
• Proactively manages provider networks in assigned areas and functions as primary internal spokesperson on network issues.
• Periodically visits network providers to inform partners about progress towards agreed-upon goals and upcoming network enhancements; coordinates account planning and maintenance issues.
• Provides development and training to Network Providers on changes and updates to TriWest processes and policies.
• Identifies issues for future educational seminars that are identified through provider interactions.
• Collaborates with Provider Education to incorporate these ideas in upcoming provider education materials and updates.
• Assists provider community with any claims issues, including Electronic Media Claim filing problems, reimbursement issues, and billing questions. Answer general questions on credentialing process and technical aspects of the Program.
• Monitors and responds to network shortfalls within region.
• Demonstrate and maintain current knowledge of all programs, contracting, credentialing, reimbursement and operational policies and TriWest initiatives, operations, and goals.
• Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
• Collaborate closely with other department leadership, staff, and executive leadership on process improvement to promote service level improvements or facilitate new processes.
• Head or participate in projects and committees assigned by Sr. Contracting Manager or Vice President.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.

Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

Leadership: Successfully manage provider relationships and lead contract negotiations; takes accountability and follows through on service related requests. Responds with an appropriate sense of urgency.

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills: Working knowledge or familiarity with Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare, TRICARE, VAPC3), and the insurance industry; skill in diplomacy and negotiation; skill in financial analysis to analyze contractual reimbursement; skill in project management; skill in presentation; proficient with Excel.

Working Conditions

Working Conditions

• Availability to work non-regular hours as necessary
• Works within a standard office environment, with travel as needed
• Must be able to obtain appropriate DITSCAP security clearance

Company Overview

Taking Care of Our Nation’s Heroes.

It’s Who We Are. It’s What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve

Our job is to make sure that America’s heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.

DoD Statement

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Benefits

We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $87,000 - $102,000 per year.

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.