Director, Ohio Market Provider Contracting

CareSource; Dayton (KY); Hybrid; USD 136,000 - 237,000; Full time

Job summary

CareSource is seeking a Director of Provider Contracting in Kentucky to execute contracting strategy and oversee provisions based on cost, quality, and analysis. The role drives regulatory compliance, supplier recruitment, and contract administration while monitoring key metrics and network adequacy to serve members effectively.

The position requires a Bachelor’s degree in a healthcare field (Master’s preferred), at least three years of contract negotiation and three years of management

Qualifications

• Bachelor’s degree in a healthcare related field, or equivalent work experience is required
• Master’s Degree or equivalent work experience is preferred
• Minimum three (3) years of contract negotiation experience is required
• Minimum three (3) years of management experience is required
• Managed care experience is highly preferred

Responsibilities

• Conduct annual effectiveness review of contracting strategies
• Ensure corporate compliance with all contracting
• Ensure an ongoing high level of staff engagement, empowerment and development
• Responsible for provider recruitment, implementation of contracts
• Responsible of contracts and testing, initiating set-up, post configuration testing, maintenance and audit of claims system
• Create contract language and review with legal to develop approved contract templates
• Administer provider contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
• Implement an efficient and effective process to on-board new providers
• Ensure network is adequate (access for members), cost-effective, competitive and stable, and meets corporate & regulatory requirements
• Responsible for ensuring all regulatory requirements for provider network are met
• Perform gap analysis to ensure no gaps and/or sanctions occur
• Identify & implement solutions that mitigate risk
• Development of corrective action plans as needed
• Responsible for access grievance intake, analysis and performance improvement initiatives
• Participate in training sessions for providers and staff as appropriate
• Support the contracting requirements of the corporation for geographic regions and products
• Implement performance improvement initiatives to improve Provider Satisfaction Scores incrementally on an annual basis
• Assist with development and review of payment policies and provider notifications
• Collaborate with appropriate personnel with process of reassignment of members related to provider terminations, as required by the state
• Perform any other job related instruction as requested

Skills

Contract negotiation

Management experience

Managed care experience

Strategic thinking

Communication

Time management

Education

Bachelor's degree

Master's degree

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Job Summary

The Director, Provider Contracting executes contracting strategy, develops provisions based on cost, quality/analysis and monitors key metrics.

Essential Functions

• Conduct annual effectiveness review of contracting strategies
• ensure corporate compliance with all contracting
• Ensure an ongoing high level of staff engagement, empowerment and development
• Responsible for provider recruitment, implementation of contracts
• Responsible of contracts and testing, initiating set-up, post configuration testing, maintenance and audit of claims system
• Create contract language and review with legal to develop approved contract templates
• Administer provider contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
• Implement an efficient and effective process to on-board new providers
• ensure network is adequate (access for members), cost-effective, competitive and stable, and meets corporate & regulatory requirements
• Responsible for ensuring all regulatory requirements for provider network are met
• Perform gap analysis to ensure no gaps and/or sanctions occur
• identify & implement solutions that mitigate risk
• development of corrective action plans as needed
• Responsible for access grievance intake, analysis and performance improvement initiatives
• Participate in training sessions for providers and staff as appropriate
• Support the contracting requirements of the corporation for geographic regions and products
• Implement performance improvement initiatives to improve Provider Satisfaction Scores incrementally on an annual basis
• Assist with development and review of payment policies and provider notifications
• Collaborate with appropriate personnel with process of reassignment of members related to provider terminations, as required by the state
• Perform any other job related instruction as requested

Education and Experience

• Bachelor’s degree in a healthcare related field, or equivalent work experience is required
• Master’s Degree or equivalent work experience is preferred
• Minimum three (3) years of contract negotiation experience is required
• Minimum three (3) years of management experience is required
• Managed care experience is highly preferred

Competencies, Knowledge and Skills

• Intermediate proficiency level with Microsoft Outlook Word, and Excel
• Knowledge of Network Management Processes & Services
• Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making
• Effective oral and written communication skills
• Critical listening and thinking skills
• Training/teaching skills
• Time management skills

Licensure and Certification

To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified. CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions

General office setting, noise level is generally quiet to moderate Perform reasonable travel, up to 30% to fulfill the duties of the position

Compensation

Compensation Range: $135,600.00 - $237,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary): Salary

Organization Level Competencies

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

Job Description Notes

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.

Equal Opportunity Employment

CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

Company Mission

Brand=CareSource The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better.

Tag line

Discover what it means to be #UniquelyCareSource.