A Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on underinsured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans).
The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.
Direct the provider network and contracting activities. Lead all aspects of provider network strategy including, access analysis, network operations and support decision makers with analysis related to reimbursement and unit cost management. Oversee the coordination and negotiation for the contracting department.
- Establish the department’s strategic vision, objectives, and policies and procedures.
- Develop, implement and maintain production and quality standards for the Contracting department.
- Oversee network development staff and external consultants in the development of provider networks across expansion markets.
- Perform periodic analyses of the provider network from a cost, coverage, and growth perspective. Provide leadership in evaluating opportunities to expand or change the network to meet Company goals.
- Manage budgeting and forecasting initiatives for product lines to networks costs and provider contracts.
- Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations.
- Conduct periodic review of provider contracting rates to ensure strategic focus is on target with overall Company strategy.
- Support market expansion and M&A activities by leading provider contract analysis related to due diligence.
- Assist health plan CEO and/or COO vendors in key provider relations and strategy.
- Ability to travel.
- Bachelor's degree or equivalent experience in Business Administration, Healthcare Administration or related field. MBA or MHA degree preferred.
- 10+ years of experience in managed care network development and provider relations/contracting management in a health care and/or managed care environment.
- Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
- Valid driver’s license.
The company offers more than just medical insurance. They pay most of your benefits costs and in some cases – they pay 100 percent. Most of the benefits not covered by the company are paid with pre-tax payroll deductions.
- Health insurance
- Dental insurance
- Vision insurance
- Flexible spending accounts (includes health care, dependent care mass transit reimbursement)
- Short- and long-term disability insurance
- Basic Life insurance
- Supplemental AD&D
- Supplemental life insurance
- Wellness Program
- 401(k) retirement with company match
- Employee stock purchase plan
- Vacation, Personal and Sick time
- Paid Company Holidays
- Employee Assistance Program (EAP)
- Training and Learning Opportunities
- Tuition Reimbursement/Educational Assistance
- Service Awards
- On-site fitness center or discount at local fitness centers (most locations)
- Discounts for select local and national products and services, including cell phones, computers and more
- Other amenities may be available, but vary by location