Strategic Provider Network Contract Lead – Hybrid

Pacific Medical Centers Corp; Renton (WA); Hybrid; USD 54,000 - 84,000; Full time

Benefits offered by this job

Health benefits

Job summary

Pacific Medical Centers (PacMed) is seeking a Network Operations leader to oversee development and maintenance of the network plan and provider handbook, evaluate network adequacy, ensure URAC and DoD compliance, and support TRICARE contract.

The role leads contract negotiations with hospitals, physician groups, and ancillary services to secure acceptable reimbursement terms and contract language, in alignment with USFHP principles.

Qualifications

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

Responsibilities

• Lead contract negotiations for acceptable reimbursement terms and contract language with all network providers across the continuum of care (hospitals, physician groups and ancillary services).
• Conduct negotiations and complete the contracting process in a timely manner in accordance with USFHP contracting principles and policies.
• Ensure providers and network members are educated in Health Plan criteria and processes.

Skills

Managed care operations

Capitated medicine

Network contracts

Contract negotiations

Education

Bachelor’s Degree in related field

Job description

Pacific Medical Centers (PacMed) is seeking a Network Operations leader to oversee development and maintenance of the network plan and provider handbook, evaluate network adequacy, ensure URAC and DoD compliance, and support TRICARE contract.

The role leads contract negotiations with hospitals, physician groups, and ancillary services to secure acceptable reimbursement terms and contract language, in alignment with USFHP principles.