Provider Contract Manager II

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Provider Contract Manager II performs intermediate‑level contracting, analysis, and provider relationship responsibilities that support building a competitive, compliant, and cost‑effective network. This role evaluates network adequacy, conducts routine provider negotiations, and manages contracting workflows with moderate independence. It collaborates across business areas to ensure contracts align with reimbursement standards, regulatory requirements, and operational needs. As a developing professional, the Contract Manager II handles moderately complex contracting assignments and contributes meaningfully to network performance and provider engagement.

Develop and maintain provider networks yielding a competitive, geographic, stable network that achieves objectives for unit cost performance and trend management. Produces an affordable and predictable network for customers and business partners. Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties.

Performs other duties as assigned.

• Support Network Optimization
• Evaluate market dynamics and provider availability to support a competitive, geographically adequate network.
• Partner with internal teams to ensure network configuration supports product and regulatory requirements.

• Review proposed terms, reimbursement structures, and negotiation considerations in alignment with company standards.
• Conduct negotiations with physicians, ancillary providers, and smaller facilities to reach compliant agreements.
• Ensure contracts follow approved templates, legal requirements, and documentation standards.
• Analyze financial impacts of proposed terms and escalations as needed.

• Serve as the primary point of contact for routine contract questions and manage provider relationship and escalations.
• Communicate performance metrics, contract requirements, and network initiatives effectively.
• Support provider understanding of reimbursement methodologies, operational workflows, and administrative processes.
• Attend provider meetings or work groups to build positive, collaborative relationships.
• Perform Data Analysis & Develop Market Insights
• Analyze claims, cost, and utilization data to detect patterns affecting contracting decisions.
• Use market intel and benchmarking to support negotiation strategy development.
• Utilize and edit models to prepare summaries or recommendations for internal review.
• Track competitor activity and regulatory updates that may impact network structure.

• Suggest enhancements to contracting workflows, tools, or documentation processes.
• Collaborate with legal, finance, provider operations, and…