Direct Contracting Manager

• Negotiation experience

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, , IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Develops and maintains provider relationships within designated state/territory that Tri West is responsible for direct contracting. Manages network development activity with network providers and recruits new providers to meet business needs. Develops hospital, physician and ancillary service agreements, ensures adherence with government operational manuals, monitors network shortfalls, and resolves access issues throughout the assigned region. Facilitates resolution of escalated provider issues, and promotes Tri West Corporate initiatives.

• Bachelor's degree in Business, Health Care Administration or equivalent experience
• Experience managing large or complex provider contracts
• 5 years of experience in a Managed Care or equivalent health care environment

• Experience in provider contracting for government programs and/or commercial lines of business
• Has established relationships and resides in the market for which the position is located.
• Management experience in the healthcare industry
• Experience in utilizing a contract management system to manage contracting workflow
• Negotiation experience
• Managing Provider Data
• Understanding Claims issues and terms

• Provides legendary service and support to maintain strong relationships with internal and external customers.
• Develops negotiation strategies for areas of responsibility to achieve individual and department performance metrics.
• Develops strategic plan to meet network adequacy needs for areas of responsibility and submits to Sr. Manager for inclusion in overall network development plans.
• Regularly reviews and determines appropriate network access and development and makes recommendations to support network build activities.
• Provides regular updates to the Director and/or VP regarding provider network development, management, and access for assigned areas.
• Monitors and ensures resolution of routine and escalated provider issues.
• Communicates information regarding market needs, competition, and industry trends to management team.
• Provides training and development to team members.
• Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
• Maintains client confidence and ensures confidential information is protected.
• Works with Provider Services leadership to accurately assess network provider needs within assigned region and establish strategies to achieve them.
• Proactively manages provider networks in assigned areas and functions as primary internal spokesperson on network issues.
• Periodically visits network providers to inform partners about progress towards agreed-upon goals and upcoming network enhancements; coordinates account planning and maintenance issues.
• Provides development and training to Network Providers on changes and updates to Tri West processes and policies.
• Identifies issues for future educational seminars that are identified through provider interactions.
• Collaborates with Provider Education to incorporate these ideas in upcoming provider education materials and updates.
• Assists provider community with any claims issues, including Electronic Media Claim filing problems, reimbursement issues, and billing questions. Answer general questions on credentialing process and technical aspects of the Program.
• M…