Mgr, Provider Network Management Contracting

1 week ago


Akron, United States Summa Health System Full time
Manager, Provider Network Management Contracting

SummaCare - 1200 E Market St, Akron, OH

Full-Time / 40 Hours / Days

Hybrid

SummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a regional, provider-owned health plan, SummaCare is based in Akron, Ohio, and provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2024 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.

Summary:
Manages the contracting team and processes with healthcare providers, including negotiation, execution, and ongoing management of contracts. Ensures that the provider network supports the organization's strategic objectives and meets the needs of members while ensuring compliance with regulatory and contractual requirements. The position will also be the Value-Based Subject Matter Expert (SME) and responsible for guiding and implementing value-based strategies within the organization.

Formal Education Required:
a.Bachelor Degree or equivalent combination of education and/or experience.

Experience and Training Required:
a.Six (6) years of Managed Care experience that has provided leadership skills to include:
i.Managed Care Provider Contracting and Reimbursement experience, that includes contracting at an independent level, focusing on value based incentive programs, demonstrated financial modeling with the ability to communicate complex concepts at all levels.
ii.Network contracting experience

Other Skills, Competencies and Qualifications:
a.Significant knowledge in health insurance
b.Ability to lead and influence effectively
c.Population Specific Competency: Ability to effectively interact with patients/customers with the understanding of their needs for self-respect and dignity

Level of Physical Demands:
a.Sedentary: Exerts up to ten pounds of force occasionally and/or a negligible amount of force frequently.

Equal Opportunity Employer/Veterans/Disabled

$40.74/hr - $61.11/hr

The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.

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