Provider Partnership Manager

VNS Health; New York (NY); On-site; USD 85,000 - 106,000; Full time

Benefits offered by this job

Referral bonus opportunities

30 days PTO + 9 holidays

Health insurance for you and family

Employer-matched retirement

Tuition reimbursement

FSAs for healthcare and dependent care

Professional growth opportunities

Internal mobility and advancement

Job summary

VNS Health in New York is seeking an experienced provider relations and contracting leader to manage an assigned provider portfolio. You will recruit providers, negotiate complex reimbursement terms, and coordinate contract implementations while working with internal teams to improve access and performance.

The role emphasizes strategic account management, data-driven decision making, and collaboration with clinical, financial, and operations groups to support Stars, HEDIS, and risk adjustment

Qualifications

• Bachelor's degree or the equivalent relevant work experience required.
• Minimum five years of progressive experience in provider contracting, provider relations, network management, healthcare finance or a related field.
• Knowledge of provider reimbursement, fee schedules and performance incentives; strong negotiation and relationship management skills.
• Proficiency in Excel-based analysis and provider data systems; familiarity with Stars/HEDIS and risk adjustment.

Responsibilities

• Owns provider relationships and account plans for an assigned portfolio, serving as the primary contact and setting priorities for service, contracting, recruitment, access and performance improvement.
• Negotiates provider agreements, renewals and amendments in complex reimbursement environments using market, claims and financial information.
• Assesses network needs and recruits providers to address gaps and improve member access.
• Leads resolution of provider service, reimbursement, contract and operational issues with cross-functional teams.
• Coordinates contract implementation across credentialing, provider data, contract administration and claims teams; manages renewals and terminations.
• Leads provider business reviews and Joint Operating Committee meetings to drive actions and close performance gaps.
• Partners to improve Stars, HEDIS and risk adjustment and incorporate priorities into plans and reviews.
• Leads value-based and quality-incentive arrangements within authority and coordinates data exchange and reporting.

Skills

Provider contracting

Provider relations

Network management

Healthcare finance

Excel analysis

Education

Bachelor's degree

Tools

Contract lifecycle management tools

Job description

Overview

Manages an assigned provider portfolio with equal responsibility for provider service and contracting, including multiple-modality providers, hospitals and health systems. Builds provider relationships, leads education and resolves service and operational issues with internal departments.Recruits providers, negotiates complex reimbursement arrangements and business terms, evaluates financial alternatives, and leads implementation, performance improvement and projects. Works independently within assigned authority, seeking senior guidance when complexity, financial exposure or nonstandard terms require it.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Owns provider relationships and account plans for an assigned portfolio, serving as the primary contact and setting priorities for service, contracting, recruitment, access and performance improvement.
• Negotiates provider agreements, renewals and amendments in complex reimbursement environments. Develop and recommend reimbursement and business terms using market, claims, utilization and financial information within approved legal, financial and business parameters.
• Assesses network needs and recruit providers to address geographic, specialty and product gaps, improve member access and support network adequacy requirements.
• Leads resolution of provider service, reimbursement, contract and operational issues. Coordinate internal subject matter experts, identify root causes, drive corrective actions and maintain provider communication through resolution.
• Coordinates accurate and timely contract implementation across credentialing, provider data, contract administration, configuration, claims and other operational teams; maintain required records and manage renewals, transitions and terminations.
• Leads provider business reviews and Joint Operating Committee meetings, using financial, quality, access and service results to establish actions, monitor progress and address performance gaps.
• Partners with providers and internal clinical, financial and operational teams to improve Stars, HEDIS, risk adjustment, medical cost, member access and member experience. Incorporate approved priorities into account plans, agreements and performance reviews.
• Negotiates and supports implementation of value-based and quality-incentive arrangements within assigned authority, including coordination of attribution, data exchange, reporting and performance management.
• Leads provider-facing and departmental projects and process improvements, including medical cost and risk-reduction initiatives, with clear objectives, timelines, ownership and measures of results.
• Provides functional guidance and coaching to Provider Partnership Consultants and Senior Consultants and contribute to improvements in team tools, templates and practices.
• Manages assigned provider accounts and negotiates within approved authority; recommends agreements for approval and escalates exceptions or nonstandard terms to the appropriate decision-maker.
• Accountable for timely contracting and implementation, provider retention and recruitment, responsive service, and achievement of agreed account and project objectives.
• Accountable for assigned financial, medical cost, quality, access and member-experience targets, including applicable unit-price, MLR, Stars, HEDIS and HCC/risk-adjustment objectives.
• Identifies and manages risks within assigned accounts and projects, leads corrective actions and escalates unresolved risks or resource barriers with recommendations.
• Participates in special projects and performs other duties as assigned.

Qualifications

Education:

Bachelor's Degree or the equivalent relevant work experience required

Work Experience:

Minimum five years of progressive experience in provider contracting, provider relations, network management, healthcare finance or a related field, including two years supporting or conducting provider negotiations requiredKnowledge of provider reimbursement, including fee schedules, case rates, per diems, prospective payment methodologies, capitation, and performance incentives. requiredAbility to evaluate how proposed contract terms affect financial performance, operations, regulatory compliance, member access and provider relationships. requiredStrong negotiation, relationship management, written and verbal communication, presentation, and conflict-resolution skills. requiredProficiency in Excel-based analysis and the use of contract lifecycle management tools and provider or customer relationship management systems. requiredWorking knowledge of network adequacy, claims administration, credentialing, provider data, quality, and regulatory requirements. requiredWorking knowledge of Stars, HEDIS, accurate and compliant risk adjustment, medical cost initiatives and value-based performance management. requiredAbility to lead projects, organize work when requirements are unclear, and gain cooperation from providers and colleagues without direct supervisory authority. Ability to communicate confidently with provider executives, handle difficult discussions professionally and make commitments within assigned authority. requiredProvider contracting or provider relations experience supporting Medicare, Medicaid, dual-eligible or managed long-term care populations, or other government-sponsored health coverage preferredWorking knowledge of provider organizations, service availability and competitive conditions in the assigned market. Uses market information to assess provider proposals, identify access gaps and recommend recruitment and contracting actions. required

Pay Range

USD $85,000.00 - USD $106,300.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.