Remote Senior Hospital Contracting Strategist

CarePlus Health Plans; Iowa (LA); On-site; USD 78,000 - 108,000; Full time

Job summary

CarePlus Health Plans seeks a Senior Hospital Contracting Strategist to initiate, negotiate, and execute physician, hospital and other provider contracts for a health insurance organization. You will report to the Director, Provider Contracting and lead complex negotiations with hospital systems and networks.

The ideal candidate has 5+ years in hospital negotiation in Medicare, strong financial analysis skills, and experience with value-based contracting.

Qualifications

• Bachelor's degree in a healthcare or related field.

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

Provider contract management

Financial analysis

Medicare/Medicaid knowledge

Contract communication

Microsoft Office

Education

Bachelor's degree

Master's Degree (preferred)

Tools

Microsoft Office

Job description

CarePlus Health Plans seeks a Senior Hospital Contracting Strategist to initiate, negotiate, and execute physician, hospital and other provider contracts for a health insurance organization. You will report to the Director, Provider Contracting and lead complex negotiations with hospital systems and networks.

The ideal candidate has 5+ years in hospital negotiation in Medicare, strong financial analysis skills, and experience with value-based contracting.