Remote Hospital Contracting Leader: Medicare & Value-Based

CarePlus Health Plans; North Carolina; On-site; USD 78,000 - 108,000; Full time

Benefits offered by this job

Bonus incentive plan

Travel opportunities

Remote position

Job summary

CarePlus Health Plans is seeking a Senior Hospital Contracting Strategist to initiate, negotiate, and execute physician, hospital and other provider contracts. The role reports to the Director, Provider Contracting and supports Medicare Advantage and Medicaid networks.

The candidate will lead hospital negotiations, analyze financial impact, and collaborate with Finance, Legal and Operations to ensure sound contracts. Remote role with required travel may apply.

Qualifications

• Bachelor's degree required.
• 5+ years hospital negotiation experience in Medicare.
• Progressive network management experience in healthcare.
• Experience negotiating managed care contracts with hospital systems.
• Ability to analyze financial impact of contract terms.
• Strong MS Office proficiency.

Responsibilities

• Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value-based agreements.
• Extensive managed care experience with expertise in hospital contracting, reimbursement methodologies, financial analysis, complex negotiations, provider relationship management, and leadership.
• Experience with Medicare Advantage, Medicaid, and value-based contracting.
• Evaluate reimbursement methodologies, including DRG, PD, Case Rates, POC, OP fee schedules, and alternative payment arrangements.
• Partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable.
• Communicate contract terms, payment structures, and reimbursement rates to providers.
• Analyze financial impact of contracts and terms.
• Maintain contracts and documentation within a tracking system.
• Help with identifying and recruiting providers based on network composition and needs.

Skills

Hospital negotiation

Managed care

Reimbursement methods

Financial analysis

Provider relations

Leadership

Medicare/Medicaid

Contract terms

MS Office

Education

Bachelor's degree

Master's degree

Tools

Microsoft Office

Job description

CarePlus Health Plans is seeking a Senior Hospital Contracting Strategist to initiate, negotiate, and execute physician, hospital and other provider contracts. The role reports to the Director, Provider Contracting and supports Medicare Advantage and Medicaid networks.

The candidate will lead hospital negotiations, analyze financial impact, and collaborate with Finance, Legal and Operations to ensure sound contracts. Remote role with required travel may apply.