Senior PN Contract Manager - St Louis, Missouri Market

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- St Louis, Missouri Market role at Medica

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- St Louis, Missouri Market role at Medica

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Senior Provider Network Contract Manager develops and maintains provider networks yielding a competitive and stable network solution that advances the objectives of the Quadruple Aim. Produces an affordable and predictable network for customers and business partners that has differentiated value from other offerings in the market. Identifies and advances strategic opportunities with providers. Establishes a creative, trusted, strategic thought partner environment with providers through interest-based relationship management.

Leverages data and insights to identify opportunities for collaboration around performance improvement across key metrics with provider 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.

This position will have a focus on expanding in the St Louis market.
This is an advanced level professional position that provides direction to other staff and performs more advanced responsibilities with minimal supervision.
Qualifications:

• Bachelor's degree or equivalent experience in related field
• 7+ years of work experience beyond degree within provider contracting
• Experience in various provider contracting methodologies, and value-based/total-cost-of care required

Skills and Abilities:

• Successfully negotiates with provider partners to achieve the organization’s value-based care goals, with emphasis on risk-based agreements that include quality and cost performance measures.
• Maintains long-term relationships with provider partners including contracting peers and leaders through regular interaction to ensure high levels of collaboration, response, and mutual benefit.
• Develops relationships by conducting meetings with provider partners, attending joint operating committee meetings, and presenting as needed in order to effectively review managed care contracting status and performance
• Bridge the gap on network participation, understand how performance impacts placement in network, advise provider and contracting team, develop solutions in partnership with analytics team, product, care management and others to improve performance.
• Experience in provider contract interpretation, and/or Provider Value based financial analysis
• Requires strong financial, analytical and problem solving skills, and understanding of legal contracts. Requires excellent communications skills, written, verbal and presentation
• Demonstrated ability to translate complex system capabilities into simple customer message
• Demonstrated ability to identify root cause and corrective actions
• Ability to drive self and others to achieve commitments
• Strong written and verbal communication skill
• Experience managing workload in deadline driven area
• Experience working with all levels within an organization, including presenting to Senior Leaders
• Experience in setting up systems for reporting and monitoring of data needed for contracts
• Facilitates the sharing of information with clinically integrated network teams by attending meetings, helping to develop agendas and presenting information as needed.

This position is a Remote role and will work remotely 100% of the time. To be eligible for consideration, candidates must have a primary home address located within St. Louis, Missouri or the surrounding area.
The full salary range for this position is $87,100 - $149,300. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base…