Provider Network Contractor

RPMGlobal; Southfield (MI); Hybrid; USD 90,000 - 140,000; Full time

Job summary

RPMGlobal is seeking a Provider Network Management Contractor to develop and maintain a competitive provider network in the Southfield, Michigan area. The role requires hybrid work with three in-office days weekly and a focus on contract negotiations, regulatory compliance, and provider education.

The candidate will drive network strategy, manage SCA and contracted statuses, and partner with Legal and QA teams to expand and optimize the network for multiple product lines including LTSS and DSNP.

Qualifications

• Bachelor’s degree or 5+ years of equivalent experience.
• 3+ years of Account Executive experience.
• Minimum of one year of contract negotiation experience.
• Demonstrated financial acumen and ability to navigate difficult conversations.
• Understanding of reimbursement methodologies, including risk-based and value-based contracting.

Responsibilities

• Supports overall network development strategy.
• Assists departmental leadership with provider satisfaction, education, and communication efforts.
• Negotiates provider contracts to achieve network strategy and maintain an adequate, compliant, and marketable network.
• Negotiates Single Case Agreement (SCA) rates and converts SCA providers to contracted status.
• Recruits and contracts providers to address network adequacy gaps, including high-complexity specialties.
• Ensures all contracts comply with Federal and State regulations, policies, and departmental procedures.
• Structures contracts that support quality initiatives such as HEDIS/CAHPS/NCQA/URAC.
• Negotiates contract terms that drive provider satisfaction.
• Works with CPNM to manage annual contracting schedule and expand the network as needed.
• Serves as a payment/fee schedule SME for complex specialties; supports Account Executives with claims resolution.
• Maintains operational knowledge of claims, payment integrity, credentialing, appeals, disputes and related processes.
• Negotiates provider agreements consistent with claims payment methodologies.
• Expands or modifies the provider network to support new products or client needs.
• Reviews contract terms and collaborates with Legal for optimal language.
• Supports contracting activities across LTSS, ACA Marketplace, and DSNP products.
• Acts as the lead negotiator for VBC in partnership with the AE.

Skills

Provider contract negotiation

Relationship management

Influencing skills

Communication skills

Financial acumen

Problem solving

Conflict resolution

Decision making

Education

Bachelor’s degree

5+ years equivalent experience

Job description

Role Overview:

The Provider Network Management Contractor is responsible for developing, contracting, and maintaining provider relationships within an assigned market. This role ensures the network is competitive, compliant, and aligned with organizational strategy.

Work Arrangement:

• Hybrid - Associate must be in the office at least three (3) days per week at our Southfield, Michigan (MI), including core days of Tuesdays and Wednesdays

Responsibilities:

• Supports overall network development strategy.
• Assists departmental leadership with provider satisfaction, education, and communication efforts.
• Negotiates provider contracts to achieve network strategy and maintain an adequate, compliant, and marketable network.
• Negotiates Single Case Agreement (SCA) rates and converts SCA providers to contracted status.
• Recruits and contracts providers to address network adequacy gaps, including high ‑ complexity specialties.
• Ensures all contracts comply with Federal and State regulations, policies, and departmental procedures.
• Structures contracts that support quality initiatives such as: Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), National Committee for Quality Assurance (NCQA), and Utilization Review Accreditation Commission (URAC)
• Negotiates contract terms that drive provider satisfaction.
• Works with CPNM (Clinical Provider Network Management) to manage the annual contracting schedule and expand the network as needed.
• Serves as a payment/fee schedule Subject Matter Expert (SME) for complex specialties such as Federally Qualified Health Centers (FQHCs), Behavioral Health (BH), anesthesia, and others; available to support Account Executives (AEs) with claims resolution.
• Maintains operational knowledge of key functions affecting the provider experience, including claims, payment integrity, provider data, credentialing, appeals, disputes, and related processes.
• Negotiates provider agreements consistent with claims payment methodologies.
• Expands or modifies the provider network to support new products or client needs.
• Reviews contract terms and collaborates with Legal to secure optimal language.
• Supports contracting activities across multiple product lines, including Long-Term Services and Supports (LTSS), Exchange (ACA Marketplace plans), and Dual Special Needs Plans (DSNP)
• Acts as the lead negotiator for VBC (Value-Based Contracting) in partnership with the AE.

Education & Experience:

• Bachelor’s degree required or 5 plus years of equivalent experience.
• 3 or more years of Account Executive experience.
• Minimum of one year of contract negotiation experience.
• Demonstrated financial acumen and ability to navigate difficult conversations.
• Minimum of one year of contract negotiation experience.
• Understanding of reimbursement methodologies, including risk ‑ based and value-based contracting.

Skills & Abilities:

• Strong provider contract negotiation, relationship management, and influencing skills.
• Ability to analyze reimbursement methodologies, fee schedules, financial performance, and contract terms.
• Knowledge of provider network adequacy, healthcare regulations, credentialing, claims, and provider data processes.
• Excellent written and verbal communication skills, with the ability to explain complex contractual and reimbursement concepts clearly.
• Strong problem-solving, conflict-resolution, and decision-making abilities.