Senior Network Contracting Analyst

CareMore Health Management Services, LLC; Nevada; Hybrid; USD 81,000 - 122,000; Full time

Job summary

CareMore Health is seeking a Senior Network Contracting Analyst to lead negotiations for complex provider agreements and manage the full contract lifecycle. You will analyze reimbursement economics, drive value-based payment initiatives, and coordinate with Finance, Legal, Compliance, and Clinical leadership to optimize network performance.

You will monitor CMS and state Medicaid rules to ensure regulatory compliance while balancing cost, access, and quality outcomes across Medicare Advantage

Qualifications

• Experience negotiating complex provider contracts and managing end-to-end lifecycle.
• Ability to analyze reimbursement scenarios and contract economics.
• Experience coordinating with cross-functional teams (Finance, Legal, Compliance).

Responsibilities

• Lead negotiations for complex primary care and specialty provider agreements, managing the full contract lifecycle from strategy development through execution and implementation.
• Develop negotiation strategies by evaluating provider performance, reimbursement methodologies, market conditions, utilization trends, quality metrics, and competitive intelligence.
• Interpret complex financial models to assess reimbursement scenarios, contract economics, provider performance, and the financial impact of proposed contract terms.
• Structure provider agreements that balance medical expense and affordability initiatives, network adequacy, quality outcomes, regulatory compliance, and long-term provider partnerships.
• Collaborate with Finance, Legal, Compliance, Provider Operations, Configuration, Credentialing, and Clinical leadership to ensure accurate implementation and operational readiness of executed agreements.
• Analyze provider network adequacy, access standards, cost trends, utilization patterns, and market opportunities to recommend strategic contracting initiatives and network optimization strategies.
• Serve as the primary contracting contact for assigned provider organizations, resolving contract interpretation questions, reimbursement issues, and operational concerns while fostering collaborative provider relationships.
• Support the development and implementation of value-based payment arrangements, including shared savings, quality incentive, bundled payment, capitation, and other alternative reimbursement models.
• Identify contracting risks and opportunities, recommending solutions that improve provider performance, member access, quality outcomes, and financial sustainability.
• Lead cross-functional contracting projects and process improvement initiatives that enhance operational efficiency, contract governance, and data integrity.
• Prepare executive-level reports, financial analyses, and contracting recommendations for Network Management leadership.
• Stay current on CMS regulations, state Medicaid requirements, healthcare market trends, and industry best practices that impact provider contracting and reimbursement.
• Foster a sense of curiosity and desire to understand how various provider relationships interact with overall CareMore strategic initiatives.
• Pivot quickly and prioritize workload in line with changing organizational objectives.

Skills

Contract negotiation

Financial modeling

Provider relations

Healthcare contracting

Job description

The Senior Network Contracting Analyst leads complex physician and specialist contracting initiatives that support CareMore Health's mission of delivering high-quality, coordinated, and cost-effective care to Medicare Advantage, Medicaid, and other managed care populations. This role independently manages the negotiation, implementation, and administration of provider agreements while providing strategic financial and market analysis to optimize network performance, provider access, and value-based care outcomes.

Key Responsibilities

• Lead negotiations for complex primary care and specialty provider agreements, managing the full contract lifecycle from strategy development through execution and implementation.
• Develop negotiation strategies by evaluating provider performance, reimbursement methodologies, market conditions, utilization trends, quality metrics, and competitive intelligence.
• Interpret complex financial models to assess reimbursement scenarios, contract economics, provider performance, and the financial impact of proposed contract terms.
• Structure provider agreements that balance medical expense and affordability initiatives, network adequacy, quality outcomes, regulatory compliance, and long-term provider partnerships.
• Collaborate with Finance, Legal, Compliance, Provider Operations, Configuration, Credentialing, and Clinical leadership to ensure accurate implementation and operational readiness of executed agreements.
• Analyze provider network adequacy, access standards, cost trends, utilization patterns, and market opportunities to recommend strategic contracting initiatives and network optimization strategies.
• Serve as the primary contracting contact for assigned provider organizations, resolving contract interpretation questions, reimbursement issues, and operational concerns while fostering collaborative provider relationships.
• Support the development and implementation of value-based payment arrangements, including shared savings, quality incentive, bundled payment, capitation, and other alternative reimbursement models.
• Identify contracting risks and opportunities, recommending solutions that improve provider performance, member access, quality outcomes, and financial sustainability.
• Lead cross-functional contracting projects and process improvement initiatives that enhance operational efficiency, contract governance, and data integrity.
• Prepare executive-level reports, financial analyses, and contracting recommendations for Network Management leadership.
• Stay current on CMS regulations, state Medicaid requirements, healthcare market trends, and industry best practices that impact provider contracting and reimbursement.
• Foster a sense of curiosity and desire to understand how various provider relationships interact with overall CareMore strategic initiatives.
• Pivot quickly and prioritize workload in line with changing organizational objectives.

Compensation Range

$81,492.00 to $122,238.00 The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.

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