Senior Provider Network Contract Specialist

Jobtailor; Renton (WA); On-site; USD 90,000 - 130,000; Full time

Job summary

Jobtailor is seeking a Network Operations professional to lead the development and maintenance of the Network Plan and provider handbook in support of the US Family Health Plan. The role focuses on evaluating network adequacy and ensuring URAC and DoD standards are met within TRICARE contracts, while representing the plan in external relations.

The position emphasizes educating providers and network members on Health Plan criteria, overseeing non-clinical utilization management, and driving

Qualifications

• 5 years of managed care operations experience.
• Experience with capitated medicine and contracted networks.
• Bachelor’s degree in a related field preferred.
• Ambulatory medicine experience preferred.
• Project management experience preferred.
• Contract negotiation experience preferred.

Responsibilities

• Develop and maintain the Network Plan and provider handbook.
• Evaluate the adequacy of the network.
• Ensure network meets URAC and DoD standards.
• Comply with all elements of the TRICARE Management Activity contract.
• Act as representative and spokesperson for US Family Health Plan.
• Educate providers and network members in Health Plan criteria and processes.
• Oversee non-clinical utilization management functions of the Health Plan.
• Lead provider contracting and network relations.
• Lead contract negotiations for reimbursement terms and contract language with all network providers.

Skills

Managed care operations

Capitated medicine

Contracted networks

Health plan contracts

Ambulatory medicine

Project management

Contract negotiation

Education

Bachelor’s degree in related field

Job description

Responsibilities

• Responsible for the development and maintenance of the Network Plan the provider handbook.
• Responsible for evaluation of the adequacy of the network.
• Assuring that the network meets URAC and DoD standards.
• Compliance with all elements of the TRICARE Management Activity contract.
• Acts as a representative and spokesperson for US Family Health Plan.
• Responsible for assuring providers and network members are educated in Health Plan criteria and processes.
• Responsible for the non‑clinical utilization management functions of the Health Plan.
• A key role in provider contracting and network relations.
• Leads contract negotiations for acceptable reimbursement terms and contract language with all network providers.

Requirements

• 5 years of Managed care operations.
• Extensive experience and understanding of capitated medicine, contracted networks and health plan contracts.
• Bachelor’s Degree in related field (preferred).
• Ambulatory medicine (preferred).
• Project management (preferred).
• Contract negotiation (preferred).