Strategic Provider Contracting Director

CareSource; Dayton (KY); Hybrid; USD 136,000 - 237,000; Full time

Job summary

CareSource is seeking a Director of Provider Contracting in Kentucky to execute contracting strategy and oversee provisions based on cost, quality, and analysis. The role drives regulatory compliance, supplier recruitment, and contract administration while monitoring key metrics and network adequacy to serve members effectively.

The position requires a Bachelor’s degree in a healthcare field (Master’s preferred), at least three years of contract negotiation and three years of management

Qualifications

• Bachelor’s degree in a healthcare related field, or equivalent work experience is required
• Master’s Degree or equivalent work experience is preferred
• Minimum three (3) years of contract negotiation experience is required
• Minimum three (3) years of management experience is required
• Managed care experience is highly preferred

Responsibilities

• Conduct annual effectiveness review of contracting strategies
• Ensure corporate compliance with all contracting
• Ensure an ongoing high level of staff engagement, empowerment and development
• Responsible for provider recruitment, implementation of contracts
• Responsible of contracts and testing, initiating set-up, post configuration testing, maintenance and audit of claims system
• Create contract language and review with legal to develop approved contract templates
• Administer provider contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
• Implement an efficient and effective process to on-board new providers
• Ensure network is adequate (access for members), cost-effective, competitive and stable, and meets corporate & regulatory requirements
• Responsible for ensuring all regulatory requirements for provider network are met
• Perform gap analysis to ensure no gaps and/or sanctions occur
• Identify & implement solutions that mitigate risk
• Development of corrective action plans as needed
• Responsible for access grievance intake, analysis and performance improvement initiatives
• Participate in training sessions for providers and staff as appropriate
• Support the contracting requirements of the corporation for geographic regions and products
• Implement performance improvement initiatives to improve Provider Satisfaction Scores incrementally on an annual basis
• Assist with development and review of payment policies and provider notifications
• Collaborate with appropriate personnel with process of reassignment of members related to provider terminations, as required by the state
• Perform any other job related instruction as requested

Skills

Contract negotiation

Management experience

Managed care experience

Strategic thinking

Communication

Time management

Education

Bachelor's degree

Master's degree

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

CareSource is seeking a Director of Provider Contracting in Kentucky to execute contracting strategy and oversee provisions based on cost, quality, and analysis. The role drives regulatory compliance, supplier recruitment, and contract administration while monitoring key metrics and network adequacy to serve members effectively.

The position requires a Bachelor’s degree in a healthcare field (Master’s preferred), at least three years of contract negotiation and three years of management