Manager Of Provider Contracting

Pacificsource Eugene , OR 97401

Posted 3 weeks ago

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview:
Manage a team of Contract Specialists and Representatives accountable to lead, develop, and maintain strong, positive contractual and overall relationships with providers. Oversee all aligned incentive contracting. Deploy resources and oversee key work processes to achieve critical goal attainment across all lines of business including commercial, Medicare and Medicaid. Proactively manage assigned provider accounts to achieve PacificSource's strategies and goals for product and provider contract development.

Essential Responsibilities:

  • Provide supervision, coaching, training, support, evaluation, and leadership to assigned staff.

  • Manage and maintain effective provider networks and monitor the adequacy of those networks.

  • Accountable for network contracting results for assigned markets or provider entities and efficiently manage resources to achieve department goals and initiatives.

  • Lead complex negotiations and implementation of provider contracts for assigned markets or provider entities and oversee various points of contact for assigned accounts with respect to negotiations and service.

  • Proactively communicate with PacificSource management on account status to facilitate proper internal support of account management efforts.

  • Develop and implement contracting strategies which meet corporate financial objectives; working within the budgetary guidelines.

  • Exercise independent judgment and communicate effectively with other leaders in the Provider Network Department and other related internal staff.

  • Communicate regularly with internal staff, departments, and district offices the status of contract negotiations and potential impact on operations throughout the negotiation process and obtain feedback as appropriate to ensure the final contract supports the PacificSource operational and strategic goals.

  • Partner with other Provider Network leaders to ensure PacificSource strategies are being met with the provider community.

  • Build and maintain positive provider relationships that foster a collaborative approach to quality care, network stability and cost containment.

  • Accountable for the relationship management for assigned provider accounts which includes the multi-disciplinary PacificSource team to provide operationally excellent service and support to the accounts.

  • Participate in provider specific and public presentations as indicated.

  • Participate in special projects related to PacificSource initiatives and other duties as assigned.

  • Demonstrate knowledge and support of PacificSource corporate initiatives.

  • Proactively develop positive working relationships with other PacificSource departments and staff to resolve provider issues.

Supporting Responsibilities:

  • Meet department and company performance and attendance expectations.

  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.

  • Perform other duties as assigned.

Work Experience: A minimum of five years of experience in managing provider relationships and provider contract negotiations. 3 years of experience managing healthcare related teams. Demonstrated ability to develop and execute strategy

Education, Certificates, Licenses: BA or BS in business, health care administration, finance, or equivalent combination of education and experience required. Master's degree preferred.

Knowledge:
Excellent public relations and interpersonal skills. Excellent written and verbal communication skills. Ability to draft contract language to meet legal criteria and familiarity with provisions in health insurance. Excellent presentation skills. Understanding of complex financial arrangements and quality programs across health care products. Knowledge of different forms of reimbursement including capitation and their ramifications on providers as well as insurers. Strong data management skills. Demonstrated knowledge of regulatory issues and network development. Strong experience and expertise in the provider environment. A thorough understanding of PacificSource products. Knowledge of provider profiling software, systems, and provider data utilization. Self-starter and the ability to lead with minimal direction. Proven ability to lead and mentor small teams. Strong organizational, planning and administrative skills. Current driver's license and the ability to travel.

Competencies

  • Adaptability

  • Building Customer Loyalty

  • Building Strategic Work Relationships

  • Building Trust

  • Continuous Improvement

  • Contributing to Team Success

  • Planning and Organizing

  • Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 15% of the time.

Our Values

  • We are committed to doing the right thing.

  • We are one team working toward a common goal.

  • We are each responsible for customer service.

  • We practice open communication at all levels of the company to foster individual, team and company growth.

  • We actively participate in efforts to improve our many communities-internally and externally.

  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements:
Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.


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Manager Of Provider Contracting

Pacificsource