Health Partner Network Manager

CareSource; Ohio; Híbrido; USD 72 000 - 116 000; Tempo integral

Resumo da oferta

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.

Qualificações

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

Responsabilidades

• 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

Conhecimentos

Negotiation

Stakeholder communication

Analytical thinking

Time management

Decision making

Teamwork

Training/mentoring

Oral communication

Written communication

Critical thinking

Formação académica

Bachelor’s degree in healthcare

Master’s degree (preferred)

Ferramentas

Microsoft Outlook

Microsoft Word

Microsoft Excel

Descrição da oferta de emprego

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 (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 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

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.

Organization Level Competencies

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

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 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.