Health Partner Network Manager

CareSource; Kentucky; On-site; USD 72,000 - 116,000; Full time

Job summary

CareSource is seeking a Health Partner Network Manager to execute contracting strategies, develop provisions based on cost and quality, and monitor key metrics for the assigned Market. This role focuses on value-based reimbursement, provider recruitment, and contract loading/credentialing.

You will analyze financial data, establish rates with leadership, and ensure compliance with regulatory requirements while building networks to support new products in the market.

Qualifications

• Bachelor’s degree in a healthcare field or equivalent years of relevant work experience is required.
• Master’s degree preferred.
• Minimum of three years of healthcare experience, including one year in managed care provider relations or provider contracting.
• Managed care experience is highly preferred.

Responsibilities

• Create, execute and administer value based reimbursement strategies as directed.
• Conduct annual effectiveness review of contracting strategies.
• Ensure corporate compliance with all contracting initiatives.
• Recruit, contract and initiate loading and credentialing processes for providers.
• Negotiate and re-negotiate hospital, ancillary and physician contracts within policy.

Skills

Negotiation skills

Provider Network Management

Microsoft Outlook

Microsoft Word

Microsoft Excel

Communication skills

Education

Bachelor’s degree in healthcare

Master’s degree

Tools

Excel

Outlook

Word

Job description

Job Summary

The Health Partner Network Manager executes the Health Partner contracting strategy, develops contract provisions based on cost, quality/analysis and monitors key metrics for the assigned Market.

Essential Functions

• 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

Education and Experience

• Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is required
• Master’s Degree is preferred
• Minimum of three (3) years of Healthcare experience, to include one (1) year of work experience in managed care provider relations or provider contracting
• Managed care experience is highly preferred

Competencies, Knowledge and Skills

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

Licensure and Certification

Must have valid driver’s license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver’s license record check and verified insurance. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated. 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 (October1– March31) 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 environment; may be required to sit or stand for extended periods of time Perform reasonable travel, up to 30% to fulfill the duties of the position

Compensation Range

$72,200.00 - $115,500.00

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

Disclaimer

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

Equal Opportunity Employer

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

#LI-TS1 Brand=CareSource

About the Mission

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. Discover what it means to be #UniquelyCareSource.