Remote Value-Based Hospital Contracting Leader

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

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) retirement plan

Paid time off

Job summary

CarePlus Health Plans is seeking a Senior Hospital Contracting Strategist/Senior Provider Contracting Professional to lead and execute hospital and provider contracts. You will negotiate terms, reimbursement rates, and amendments for a health insurance organization, reporting to the Director, Provider Contracting.

The role requires extensive hospital contracting and managed care experience, with the ability to analyze financial impact and work cross-functionally to ensure contracts are

Qualifications

• Bachelor's degree is required.
• 5 or more years of Hospital negotiation experience in Medicare/Medicaid.
• Leading negotiations for hospital and health system agreements including reimbursement, terms, amendments, renewals, and value-based agreements.
• 5+ years of 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, understand and communicate financial impact of contract terms, payment structures and reimbursement rates.
• Understand and interpret hospital contract language.
• Proficiency in Microsoft Office (Word, Excel, PowerPoint).

Responsibilities

• Lead negotiations for hospital and health system agreements, including reimbursement and terms.
• Manage reimbursement methodologies and contract terms to achieve favorable outcomes.
• Analyze financial impact of contracts and communicate results to providers.
• Coordinate with Finance, Legal, Network Management, Claims, and Operations to ensure contracts are sound.
• Communicate contract terms and payment structures to providers.
• Maintain contracts and documentation in tracking systems.
• Identify and recruit providers based on network needs.
• Support value-based contracting initiatives.

Skills

Negotiation

Managed care

Medicare/Medicaid

Value-based contracting

Financial analysis

Provider relations

Contract language

Microsoft Office

Education

Bachelor's degree

Master's Degree

Tools

Excel

PowerPoint

Word

Job description

CarePlus Health Plans is seeking a Senior Hospital Contracting Strategist/Senior Provider Contracting Professional to lead and execute hospital and provider contracts. You will negotiate terms, reimbursement rates, and amendments for a health insurance organization, reporting to the Director, Provider Contracting.

The role requires extensive hospital contracting and managed care experience, with the ability to analyze financial impact and work cross-functionally to ensure contracts are