Senior Provider Network Contract Specialist

Responsibilities

• Responsible for the development and maintenance of the Network Plan the provider handbook.
• Responsible for evaluation of the adequacy of the network.
• Assuring that the network meets URAC and DoD standards.
• Compliance with all elements of the TRICARE Management Activity contract.
• Acts as a representative and spokesperson for US Family Health Plan.
• Responsible for assuring providers and network members are educated in Health Plan criteria and processes.
• Responsible for the non‑clinical utilization management functions of the Health Plan.
• A key role in provider contracting and network relations.
• Leads contract negotiations for acceptable reimbursement terms and contract language with all network providers.

• 5 years of Managed care operations.
• Extensive experience and understanding of capitated medicine, contracted networks and health plan contracts.
• Bachelor’s Degree in related field (preferred).
• Ambulatory medicine (preferred).
• Project management (preferred).
• Contract negotiation (preferred).