Provider Network Contract Manager III

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 Network Contractor III is responsible for developing, negotiating, and maintaining a competitive and geographically comprehensive provider network that supports affordability, trend management, and overall business objectives. This role ensures contracts align with organizational reimbursement standards, regulatory requirements, and internal controls while supporting predictable network performance for customers and partners. It builds strong, collaborative relationships with hospitals, physicians, pharmacies, and ancillary providers to ensure an appropriate mix of specialties and network stability.

As a high-level contributor, the Provider Network Contractor works independently, manages complex contracting initiatives, and serves as a resource to internal teams. Performs other duties as assigned.

• Network Development & Optimization
  • Evaluate market dynamics and provider availability to support a competitive, geographically adequate network
  • Monitor unit cost performance and trend metrics to align network structure with affordability goals
  • Coordinate with internal stakeholders to ensure network decisions support product and regulatory requirements
• Provider Contract Negotiation & Management
  • Assess contract terms, reimbursement structures, and negotiation strategies in alignment with company standards and financial targets
  • Lead negotiations with hospitals, physicians, and ancillary providers to reach sustainable and mutually beneficial agreements
  • Ensure all contracts adhere to templates, legal requirements, and internal process controls
  • Conduct financial analyses to evaluate the cost and utilization impacts of proposed and final terms
• Provider Relationship Management & Engagement
  • Build strong relationships with contracted providers and serve as a key contact for addressing concerns, clarifying expectations, and resolving issues
  • Facilitate communication around performance data, contract requirements, and network initiatives
  • Support provider understanding of reimbursement models and operational workflows
  • Represent the organization in provider meetings, partnership discussions, and network-related forums
• Data Analysis & Market Insight Development
  • Analyze claims, cost, and utilization patterns to identify opportunities for improved contracting or network performance
  • Use market intelligence and bench-marking to support negotiation strategies and decision-making
  • Utilize and edit models to prepare summaries and recommendations for leadership based on financial and operational data
  • Monitor competitor actions and regulatory changes with potential network impact
• Process Improvement & Cross Functional Collaboration
  • Recommend improvements to contracting processes, documentation practices, and workflow efficiency
  • Partner with legal, finance, provider operations, and medical management teams to ensure smooth contract implementation
  • Support cross-team initiatives such as value-based contracting, quality programs, or cost-of-care strategies
  • Share expertise and guidance with colleagues to strengthen team capabilities and contracting effectiveness

• Bachelor's degree or equivalent experience in related field
• 5+ years of work experience within a healthcare environment

• Payer/Provider contract negotiation experience
• Revenue cycle knowledge and/or experience
• Experience building relationships and establishing trust at all levels
• Health plan operations and/or provider operations experience
• Excellent communication (written, verbal and presentation) skills
• Proven track record of cultivating and maintaining effective, collaborative external relationships where the parties trust information that's conveyed
• A proven track record as a successful contract negotiator for health care services, provider or health plan
• Knowledge of provider contracting…