Strategic Health Plan Contracts Lead

Community Bridges Inc.; Phoenix (AZ); On-site; USD 95,000 - 125,000; Full time

Benefits offered by this job

5 weeks PTO

Hospital indemnity

Pet insurance

Dependent care savings

401K with employer match

Wellness programs

Tuition reimbursement

Competitive pay

Job summary

Community Bridges, Inc. (CBI) is seeking a Health Plan Contract Manager to oversee contracts with Medicaid, Medicare, and Commercial payers. You will implement strategies from the Executive Leadership Team and collaborate with all departments to align contracts with requirements.

You will participate in payer Joint Operations Committee meetings and work with Accountable Care Organizations, reporting to the VP Payer Relations for status updates and ensuring timely legal reviews before signatures.

Qualifications

• Bachelor’s degree in Business Administration or Healthcare Management required; MBA preferred.
• Two or more years of leadership experience required.
• Five or more years in contract management/negotiation of healthcare contracts.
• Experience with rate setting and analysis.
• Working knowledge of claims/billing, coding, credentialing.
• AHCCCS health plan contracting experience strongly preferred.
• Knowledge of Medicaid, Medicare, and Commercial systems.
• Experience with multiple reimbursement strategies.
• ACO contracting experience preferred.
• Multi-state payer strategy contracting experience preferred.

Responsibilities

• Contract healthcare services with Medicaid, Medicare and Commercial payers and government entities.
• Implement contracting strategies identified by ELT and coordinate with internal departments.
• Serve as liaison for health plan contract needs and inquiries.
• Participate in payer Joint Operations Committee (JOC) meetings and ACO contracts.
• Provide status updates to VP Payer Relations and ensure legal review prior to signature.
• Establish structures to track contracts through their lifespan to keep them current.

Skills

Leadership

Contract management

Negotiation

Rate setting

Claims/billing knowledge

Credentialing

AHCCCS experience

ACO contracting

Payer strategy

Commercial contracting

Education

Bachelor’s Degree in Business Administration or Healthcare Management

MBA preferred

Job description

Community Bridges, Inc. (CBI) is seeking a Health Plan Contract Manager to oversee contracts with Medicaid, Medicare, and Commercial payers. You will implement strategies from the Executive Leadership Team and collaborate with all departments to align contracts with requirements.

You will participate in payer Joint Operations Committee meetings and work with Accountable Care Organizations, reporting to the VP Payer Relations for status updates and ensuring timely legal reviews before signatures.