Provider Contract Specialist Lead

Spectrum Health; Grand Rapids (MI); On-site; USD 110,000 - 140,000; Full time

Benefits offered by this job

Comprehensive benefits

On-demand pay

Retirement plan

Job summary

Corewell Health is seeking a senior professional to lead managed care contracting initiatives in Grand Rapids. You will coordinate contract development, negotiations, and renewals, guiding junior staff and interfacing with senior leaders to align terms with organizational goals.

Applicants should have 10+ years in healthcare payer/provider roles with strong data analytics and finance/contract management experience. Strong negotiation skills and legal awareness are essential.

Qualifications

• Bachelor's Degree or equivalent in Business Administration, Health Care Administration, Finance, Health and Human services or related field.
• At least 10 years of experience within the healthcare system in either a payer or provider capacity in a direct, outward-facing role that includes data analytics.
• Relevant experience in finance or contract management.

Responsibilities

• Manages the contract development and negotiations process for delivery system network initiatives.
• Enters/maintains/oversees current information in the internal contract repository and system contract database.
• Leads the proactive, methodical management of contracts from initiation through execution, compliance and renewal.
• Creates contracting strategies and deploys techniques that move payers to desired contract terms according to guidelines and preferred language.
• Provides effective oversight of contract implementation process ensuring all contracts are within required guidelines and financial parameters and timely.
• Leads the drafting, review, negotiation, and execution of assigned payer contracts from start to finish.
• Develops regular reports on contract milestones and performance; and informs internal customers of activities and progress, through both verbal and written communications.
• Interfaces routinely with leadership on an independent basis while understanding other political sensitivities.
• Applies critical thinking skills to analyze complex situations, identify root causes, and evaluate alternative solutions.
• Investigates operational, clinical, or administrative issues by gathering relevant data, conducting interviews, reviewing documentation, and assessing system processes.
• Formulates logical, evidence-based conclusions and make sound recommendations to resolve problems or improve outcomes.
• Collaborates with cross-functional teams to develop and implement corrective actions, ensuring alignment with organizational policies and goals.
• Monitors the effectiveness of implemented language and renegotiates as needed.

Skills

Contract negotiation

Data analytics

Healthcare contracting

Anti-trust laws

Education

Bachelor's Degree

Master's Degree preferred

Job description

Job Summary Lead by example, holding positive and respectful relationships with highly-valued and complex internal and external customers. The successful candidate will understand the nuances of managed care contracting, analytics, managed care payers, delivery system’s primarily operations, functions of a revenue cycle, and know where and when it is appropriate to engage senior leaders. The candidate will also understand the latest healthcare trends and leverage their past years of experience to creatively design contracts that add value for Corewell Health. Lead tactically by helping junior staff with complex contract terms and negotiating techniques to help prepare for successful contract discussions. The successful candidate will also lead administratively by managing internal communications as it relates to the contracting process and tracking success while driving key projects. The candidate will also gather market and competitive intelligence through secondary sources as it relates to payers and providers and health care policy to increase knowledge providing leverage for the department to use in contract negotiations.

Essential Functions

• Manages the contract development and negotiations process for delivery system network initiatives.
• Enters/maintains/oversees current information in the internal contract repository and system contract database.
• Leads the proactive, methodical management of contracts from initiation through execution, compliance and renewal.
• Creates contracting strategies and deploys techniques that move payers to desired contract terms according to guidelines and preferred language.
• Provides effective oversight of contract implementation process ensuring all contracts are within required guidelines and financial parameters and timely.
• Leads the drafting, review, negotiation, and execution of assigned payer contracts from start to finish.
• Develops regular reports on contract milestones and performance; and informs internal customers of activities and progress, through both verbal and written communications.
• Interfaces routinely with leadership on an independent basis while understanding other political sensitivities.
• Applies critical thinking skills to analyze complex situations, identify root causes, and evaluate alternative solutions.
• Investigates operational, clinical, or administrative issues by gathering relevant data, conducting interviews, reviewing documentation, and assessing system processes.
• Formulates logical, evidence-based conclusions and make sound recommendations to resolve problems or improve outcomes.
• Collaborates with cross-functional teams to develop and implement corrective actions, ensuring alignment with organizational policies and goals.
• Monitors the effectiveness of implemented language and renegotiates as needed.

Qualifications

• Required Bachelor's Degree or equivalent in Business Administration, Health Care Administration, Finance, Health and Human services or related degree programs.
• At least 10 years of experience within the healthcare system in either a payer or provider capacity in a direct, outward-facing role that includes data analytics.
• Relevant experience in finance or contract management.

Preferred

• Masters Degree in business administration, health care administration, finance, health and human services.
• Experience in a team lead or project management role responsible for personnel and their success.
• Experience working with legal staff.

Skills

• Skills in best practices for contract negotiation tactics and strategies.
• Working knowledge of anti-trust laws.

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Corewell Health Place - 100 Corewell Drive NW - Grand Rapids Department Name Managed Care Contracting - Corporate Employment Type Full time Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 8:00 a.m. to 4:30 p.m. Days Worked Monday to Friday Weekend Frequency N/A

Employment Notification

We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Equal Employment Opportunity

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

Evolving Culture and Inclusion

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

Contact

You may request assistance in completing the application process by calling 616.486.7447.

Company Overview

People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy and transparency. Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 60,000+ dedicated people—including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities—and Priority Health, a provider-sponsored health plan serving more than 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.