Provider Networks

3 weeks ago

Minneapolis MN, United States UCare Full time

Job DescriptionABOUT UCAREUCare offers Medicare, Medicaid, Individual and Family health plans – powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.WORKING AT UCAREWorking at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job. Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 14 consecutive years since the awards program began. It’s a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.Position DescriptionAs a Provider Networks and Contracting Manager – Expansion/Growth, you will be responsible for managing a UCare contracting team, including staff who support UCare’s growth and expansion markets. The team’s goal is to develop, negotiate, implement, oversee, and maintain professional, hospital, ancillary and/or care system provider contracts, in both current and expansion markets. Your team is responsible for ensuring competitive contractual relationships with providers in accordance with regulatory, operational, and financial goals and standards, in addition to managing strategic provider projects and special initiatives. The team is also accountable for building and maintaining strong provider relationships. Coach, mentor and manage a high-performing team of professionals to achieve favorable and timely contract terms, build and strengthen relationships with key providers, and support health equity, market growth and expansion, and other UCare strategic provider-related goals. Participate in and/or lead the development of provider network and contracting strategy, including focusing on new strategic growth opportunities. Deliver provider intelligence and insights to key internal provider forums to recommend and inform direction and decisions. Assist with development and management of key contracting initiatives, including implementation of value-based models. Support UCare’s efforts towards use of creative and innovative approaches to manage and advance its position in the local and national health care marketplace. Manage negotiation and project plans by provider, growth, or expansion market and/or network type in collaboration with team and other internal stakeholders. Report and update status to key leadership members and committees. Develop and maintain provider networks to ensure adequate coverage for all states and products. Monitor new, existing and expansion networks and develop action plans for addressing any deficiencies. Initiate and orchestrate provider recruitment, contracting, oversight, reporting and related development efforts. Partner with your team and assigned providers to explore strategic, operational, clinical, quality and financial opportunities. Collaborate with internal departments to bring interdisciplinary team approach to meetings, data sharing, reporting and other key areas. Participate on assigned UCare committees and work groups to represent departmental interests. Regularly engage department staff to meet committee objectives and report status to department leadership, as appropriate. Assist in content responses related to Requests for Proposals, in both current and growth/expansion markets. Support the Provider Relations and Contracting Director, in collaboration with legal, on Participating Provider Agreements, Letters of Intent and other documents needed for development of current and expansion markets. Other projects and duties, as assigned.Job RequirementsEducationBachelor’s degree in health care management, finance or related field required. Demonstrated experience may be considered in lieu of degree.Required ExperienceAt least five or more years of experience in a health plan or health care organization with responsibility for provider related functions (network analysis, contracting, reimbursement, etc.). Proven ability to work in a matrix environment and lead cross-departmental teams. Knowledge of health plan functions including: product management, operations, marketing/sales, compliance, information systems, data analysis and clinical.  At least three years managerial/leadership experience.   Preferred ExperienceKnowledge of local and other provider systems. Familiarity with state and federal health care programs, including Medicare, Medicaid and Affordable Care Act (ACA) plans. Experience drafting and interpreting contracts.THE UCARE DIFFERENCEThe UCare difference is our people power – employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.  Job DetailsJob Type: Active - Regular full-timeCategory: OtherSalaried: Salaried

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