Provider Network Contract Manager III

Medica; St. Louis (MO); Presencial; USD 79 000 - 135 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical insurance

Dental insurance

Vision insurance

Paid time off

401K

Holidays

Volunteer time off

Resumo da oferta

Medica is a nonprofit health plan serving communities in multiple states. The Provider Network Contractor III develops, negotiates, and maintains a comprehensive provider network to support affordability and regulatory compliance.

The role builds strong relationships with hospitals, physicians, and ancillary providers, leading complex contracting initiatives. Onsite office work is required at Medica locations; eligibility for incentive pay is noted in the posting.

Qualificações

• Bachelor's degree or equivalent experience in related field.
• 5+ years of work experience within a healthcare environment.
• Payer/Provider contract negotiation experience (preferred).
• Revenue cycle knowledge and/or experience (preferred).
• Excellent communication skills (written, verbal and presentation) and ability to build external relationships.
• Knowledge of provider contracting components and risk-based contracting (preferred).

Responsabilidades

• Develop, negotiate, and maintain a competitive provider network aligned with affordability and regulatory requirements.
• Lead contract negotiations with hospitals, physicians, and ancillary providers.
• Analyze market dynamics, costs, and utilization to inform network strategy.
• Collaborate with legal, finance, and operations to implement contracts.
• Represent the organization in provider meetings and network initiatives.

Conhecimentos

Healthcare experience

Contract negotiation

Relationship building

Financial analysis

Cross-functional collaboration

Formação académica

Bachelor's degree or equivalent experience in related field

Descrição da oferta de emprego

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Provider Network Contractor III is responsible for developing, negotiating, and maintaining a competitive and geographically comprehensive provider network that supports affordability, trend management, and overall business objectives. This role ensures contracts align with organizational reimbursement standards, regulatory requirements, and internal controls while supporting predictable network performance for customers and partners. It builds strong, collaborative relationships with hospitals, physicians, pharmacies, and ancillary providers to ensure an appropriate mix of specialties and network stability. As a high-level contributor, the Provider Network Contractor works independently, manages complex contracting initiatives, and serves as a resource to internal teams. Performs other duties as assigned.

Key Accountabilities

• Network Development & Optimization
  • Evaluate market dynamics and provider availability to support a competitive, geographically adequate network
  • Monitor unit cost performance and trend metrics to align network structure with affordability goals
  • Coordinate with internal stakeholders to ensure network decisions support product and regulatory requirements
• Provider Contract Negotiation & Management
  • Assess contract terms, reimbursement structures, and negotiation strategies in alignment with company standards and financial targets
  • Lead negotiations with hospitals, physicians, and ancillary providers to reach sustainable and mutually beneficial agreements
  • Ensure all contracts adhere to templates, legal requirements, and internal process controls
  • Conduct financial analyses to evaluate the cost and utilization impacts of proposed and final terms
• Provider Relationship Management & Engagement
  • Build strong relationships with contracted providers and serve as a key contact for addressing concerns, clarifying expectations, and resolving issues
  • Facilitate communication around performance data, contract requirements, and network initiatives
  • Support provider understanding of reimbursement models and operational workflows
  • Represent the organization in provider meetings, partnership discussions, and network-related forums
• Data Analysis & Market Insight Development
  • Analyze claims, cost, and utilization patterns to identify opportunities for improved contracting or network performance
  • Use market intelligence and bench-marking to support negotiation strategies and decision-making
  • Utilize and edit models to prepare summaries and recommendations for leadership based on financial and operational data
  • Monitor competitor actions and regulatory changes with potential network impact
• Process Improvement & Cross Functional Collaboration
  • Recommend improvements to contracting processes, documentation practices, and workflow efficiency
  • Partner with legal, finance, provider operations, and medical management teams to ensure smooth contract implementation
  • Support cross-team initiatives such as value-based contracting, quality programs, or cost-of-care strategies
  • Share expertise and guidance with colleagues to strengthen team capabilities and contracting effectiveness

Required Qualifications

• Bachelor's degree or equivalent experience in related field
• 5+ years of work experience within a healthcare environment

Preferred Qualifications

• Payer/Provider contract negotiation experience
• Revenue cycle knowledge and/or experience
• Experience building relationships and establishing trust at all levels
• Health plan operations and/or provider operations experience
• Excellent communication (written, verbal and presentation) skills
• Proven track record of cultivating and maintaining effective, collaborative external relationships where the parties trust information that’s conveyed
• A proven track record as a successful contract negotiator for health care services, provider or health plan
• Knowledge of provider contracting components and strategies such as but not limited to risk-based contracting, financial models, operational impact and data analytics
• Strong financial, analytical and problem-solving skills, and understanding of legal documents

This position is an Office role, which requires an employee to work onsite at our Minnetonka, MN, Madison, WI, Omaha, NE or St. Louis, MO office, on average, 3 days per week.

The full salary grade for this position is $78,700 - $134,900. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $78,700 - $118,020. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.