Remote Hospital Contracting Leader: Value‑Based Strategy

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

Benefits offered by this job

Remote position

Travel as needed

Job summary

CarePlus Health Plans seeks a Senior Hospital Contracting Strategist to lead and execute provider contracts for hospitals, physicians, and other providers. You will report to the Director, Provider Contracting and shape contracting strategies across a broad provider network.

Responsibilities include negotiating hospital and system agreements, evaluating reimbursement methods, and collaborating with Finance, Legal, and Operations to ensure contracts are financially sound.

Qualifications

• Bachelor's degree required.
• 5+ years hospital negotiation experience (Medicare).
• Lead negotiations for hospital and health system agreements, including reimbursement terms, amendments, renewals, and value-based agreements.
• 5+ years progressive network management experience including hospital contracting and network administration in a healthcare company.
• Experience negotiating managed care contracts with Hospital systems including post-acute and physicians.
• Analyze, communicate financial impact of contract terms and reimbursement rates to providers.
• Understand and interpret hospital contract language.
• Proficient in Microsoft Word, Excel and PowerPoint.

Responsibilities

• Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value-based agreements.
• Extensive managed care experience with hospital contracting, reimbursement methodologies, financial analysis, and provider relationships.
• Negotiate Medicare Advantage, Medicaid, and value-based contracting.
• Evaluate reimbursement methods (DRG, PD, Case Rates, POC, OP fee schedules, etc.).
• Collaborate with Finance, Legal, Network Management, Claims, and Operations to ensure contracts are financially sound.
• Communicate contract terms and payment structures to providers.
• Analyze financial impact of contracts and terms.
• Maintain contracts in tracking system.
• Assist in identifying and recruiting providers based on network needs.

Skills

Hospital negotiations

Reimbursement

Financial analysis

Value-based contracting

Provider relationship management

Leadership

Microsoft Office

Education

Bachelor's degree

Master's degree (Preferred)

Tools

Word

Excel

PowerPoint

Job description

CarePlus Health Plans seeks a Senior Hospital Contracting Strategist to lead and execute provider contracts for hospitals, physicians, and other providers. You will report to the Director, Provider Contracting and shape contracting strategies across a broad provider network.

Responsibilities include negotiating hospital and system agreements, evaluating reimbursement methods, and collaborating with Finance, Legal, and Operations to ensure contracts are financially sound.