Senior Provider Network Contract Specialist - USFHP

Providence Health Plan Group; Renton (WA); Hybrid; USD 54,346 - 84,364; Full time

Benefits offered by this job

Retirement 401(k) Savings Plan with employer matching

Health care benefits (medical, dental, vision)

Paid parental leave and vacation benefits

Disability insurance

Job summary

Providence Health Plan Group in Renton, WA, is seeking an experienced professional to manage the Network Plan and ensure compliance with URAC and DoD standards. The role involves developing and educating network providers on health plan criteria, as well as conducting negotiations with providers for competitive reimbursement terms.

The ideal candidate will have a strong background in managed care operations, extensive experience in contract negotiations, and a Bachelor’s Degree in a related field. The position offers a hybrid work model and a comprehensive benefits package.

Qualifications

• Minimum of 5 years in managed care operations.
• Experience with capitated medicine and health plan contracts.
• Strong skills in contract negotiation and project management.

Responsibilities

• Develop and maintain the Network Plan and provider handbook.
• Conduct contract negotiations with network providers.
• Ensure compliance with URAC, DoD standards, and contracts.

Skills

Managed care operations

Contract negotiation

Capitated medicine

Project management

Education

Bachelor’s Degree in related field

Job description

Job Description

Responsible for the development and maintenance of the Network Plan the provider handbook, for evaluation of the adequacy of the network, for assuring that the network meets URAC and DoD standards, and that there is compliance with all elements of the TRICARE Management Activity contract. Understands the attitudes and values of the community and establishes effective working relationships with stakeholders to increase resources and collaboration. Acts as a representative and spokesperson for US Family Health Plan both internally and externally. 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. Responsible for compliance with the DoD contract regarding network and utilization issues. Responsible for a key role in provider contracting and network relations.

Leads contract negotiations for acceptable reimbursement terms and contract language with all network providers across the continuum of care. (i.e. hospitals, physician groups and ancillary services). Will conduct negotiations and complete the contracting process in a timely manner in accordance with USFHP contracting principles, organizational policies and procedures and all elements of the TRICARE Management Activity contract.

Required qualifications

• 5 years of Managed care operations.
• Extensive experience and understanding of capitated medicine, contracted networks and health plan contracts.

Preferred qualifications

• Bachelor’s Degree in related field
• Ambulatory medicine.
• Project management.
• Contract negotiation.

Compensation

Pay Range: $39.45 - $61.24

Benefits

Retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more.

Equal Opportunity Employer

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

About the Team

Pacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with outpatient clinics and primary and specialty care providers in King, Snohomish and Pierce counties. We combine decades of patient-centered care with cutting-edge technology, first-class facilities and board-certified providers.

Contact and Details

Requisition ID: 442162
Company: Pacific Medical Jobs
Job Category: Provider Network
Job Function: Health Plans Services
Job Schedule: Full time
Job Shift: Day
Career Track: Business Professional
Department: 3060 WA USFHP
Address: WA Renton 620 Naches Ave SW
Work Location: Blackriver Corporate Park-Renton
Workplace Type: Hybrid