Senior Hospital Contracting & Value-Based Strategist

CarePlus Health Plans; Arizona; 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

Disability insurance

Life insurance

Job summary

CarePlus Health Plans seeks a Senior Hospital Contracting Strategist to initiate, negotiate, and execute provider contracts, including hospital and physician agreements. You will report to the Director, Provider Contracting, and collaborate with Finance, Legal, Network Management, and Operations to ensure financially sound contracts.

The role requires extensive managed care experience, Medicare/Medi-Cal familiarity, and strong negotiation and analytical skills.

Qualifications

• Bachelor's degree required; five+ years hospital negotiation experience in Medicare.
• Experience leading negotiations for hospital and health system agreements with reimbursement terms.
• Five+ years progressive network management in healthcare, including hospital contracting.
• Experience negotiating managed care contracts with hospitals and post-acute providers.
• Ability to analyze and communicate financial impact of contract terms and rates.
• Ability to understand and interpret hospital contract language.
• Proficient in Microsoft Word, Excel, and PowerPoint.

Responsibilities

• Lead negotiations for hospital and health system agreements, including reimbursement and terms.
• Manage evaluations of DRG, case rates, OP fee schedules and value based contracting.
• Coordinate with Finance, Legal, Network Management, Claims and Operations to ensure contracts are sound.
• Communicate contract terms and payment structures to providers.
• Analyze financial impact and maintain contract documentation.

Skills

Hospital negotiation

Medicare

Network management

Value based contracting

Contract language interpretation

Financial analysis

Communication with providers

Leadership

Education

Bachelor's degree

Master's degree

Tools

Microsoft Office Suite

Job description

CarePlus Health Plans seeks a Senior Hospital Contracting Strategist to initiate, negotiate, and execute provider contracts, including hospital and physician agreements. You will report to the Director, Provider Contracting, and collaborate with Finance, Legal, Network Management, and Operations to ensure financially sound contracts.

The role requires extensive managed care experience, Medicare/Medi-Cal familiarity, and strong negotiation and analytical skills.