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Network Development & Contracting Manager

Network Development & Contracting Manager

Requisition ID 
2018-5428
# of Openings 
1
Address 
100 Front Street
Job Locations 
US-MA-Worcester
Posted Date 
4/13/2018
Category 
Management
Department 
Contracting and Reimbursement
Job Code 
MM312

More information about this job

Overview

Glob Top Places to WOrk 17

 

 

Reliant Medical Group is seeking a Network Development and Contracting Manager to join our excited and innovative organization!

 

Full Time: 40

Hours: Monday - Friday 8:30AM - 5:00PM

 

Responsible for developing and implementing the organization’s network of preferred referral providers, including hospitals, skilled nursing facilities, home health providers, ambulatory surgery centers, behavioral health providers, and ancillary service providers.  Collaborates with clinical and population health staff to identify patient needs for services that cannot be provided within the organization, develop criteria for network inclusion, and define service standards.  Conducts primary and secondary market research to identify outside providers that offer needed services, and works with the Vice President, Payer Contracting and Network Strategy to develop a comprehensive network strategy and innovative payment models that align financial incentives.  Responsible for payment modeling, contract negotiation, and all aspects of contract management with preferred referral providers.  Serves as corporate point of contact for all network development related needs. Prepares formal presentations of results to management. Serves as a network development and contracting resource for all levels of management.

Responsibilities

  • In conjunction with clinical and population health staff, identifies patient needs for services that cannot be provided within the organization, develops criteria for network inclusion, and defines service standards 
  • Conducts business research and market analyses to identify and evaluate outside providers that offer medical services that cannot be provided within Reliant 
  • Makes recommendations to management on network development opportunities, and works with the Vice President of Payer Contracting and Network Strategy to develop a comprehensive network contracting strategy 
  • Identifies trends in alternative payment models, and leads the analytics work to develop innovative payment and contracting models that align financial incentives with preferred referral providers 
  • Develops negotiation strategies that reduce total medical expense and improve quality for Reliant patients 
  • Completes financial analyses/scenario analyses of various payment and negotiation options. Analyzes and breakdowns various contract proposals 
  • Negotiates appropriate business terms and service level agreements, including financial terms, service standards, and legal language, with non-Reliant providers consistent with organizational strategy and policies 
  • Systematically reviews contract compliance with negotiated payment terms, service standards, and expected quality outcomes 
  • Identifies, prioritizes and surfaces network contract issues that need to be addressed with preferred referral providers upon re-negotiations 
  • Identifies market and industry trends in the service lines for which Reliant utilizes referral providers, and incorporates these trends into the network development and contracting strategy
  • Communicates contracting results and performance of contracted providers to senior management, clinical/population health leadership, and financial planning and accounting 
  • Directs and supervises assigned personnel including performance evaluations, scheduling, orientation, and training. Makes recommendations on employee hiring, transfers, promotions, salary changes, discipline, terminations, and other similar actions. Resolves grievances and other personnel problems within position responsibilities 
  • Develops and recommends the operating and capital budgets for the areas managed. Manages activities to assure financial goals met. Monitors expenditures for compliance with the approved budget. Resolves discrepancies 
  • Coordinates the assignment of tasks and helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved 
  • Provides effective direction, guidance, and leadership over the staff for effective teamwork and motivation, and fosters the effective integration of efforts with clinic-wide initiatives 
  • Ensures compliance with regulatory agencies such as DPH, etc. Develops and maintains procedures necessary to meet the regulatory requirement 
  • Ensures that assigned area complies with clinic established policies, quality assurance programs, safety, and infection control policies and procedures 
  • Ensures adequate equipment and supplies for assigned area 
  • Ensures compliance with all health and safety regulations and requirements 
  • Performs similar or related duties as required or directed 
  • Regular, reliable and predicable attendance is required

Qualifications

  • Bachelor’s Degree with a preference for Master’s Degree in Business Administration or Health Care Administration 
  • 6+ years of payer or provider contracting experience within a commercial insurance organization or large provider organization is required, including financial analysis, negotiation, contract compliance, and performance management 
  • The ideal candidate would have experience working with value-based contracting arrangements
  • Experience in strategy development, business research, and market analysis is preferred
  • Proficiency with MS Office applications (Excel, Word, PowerPoint) is required
  • Advanced project management and organizational skills are essential, along with excellent interpersonal and communication skills

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