Health Network Contracts & Partnerships Lead

CareSource; Ohio; Hybrid; USD 72,000 - 116,000; Full time

Job summary

CareSource is seeking a Health Partner Network Manager to execute contracting strategy, develop provisions based on cost and quality, and monitor key market metrics. You will negotiate hospital, physician, and behavioral health contracts and build networks for new products.

Responsibilities include recruiting providers, loading/credentialing, analyzing financial data, and ensuring regulatory compliance within the assigned market.

Qualifications

• Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is required.
• Master’s Degree is preferred.

Responsibilities

• 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

Skills

Negotiation

Stakeholder communication

Analytical thinking

Time management

Decision making

Teamwork

Training/mentoring

Oral communication

Written communication

Critical thinking

Education

Bachelor’s degree in healthcare

Master’s degree (preferred)

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

CareSource is seeking a Health Partner Network Manager to execute contracting strategy, develop provisions based on cost and quality, and monitor key market metrics. You will negotiate hospital, physician, and behavioral health contracts and build networks for new products.

Responsibilities include recruiting providers, loading/credentialing, analyzing financial data, and ensuring regulatory compliance within the assigned market.