Senior Contract Manager

4 days ago

Canton, Massachusetts, United States Point32Health Full time
Job Summary

The Senior Contract Manager will play a critical role in supporting all Lines of Business, including Commercial, Senior Products, and Public Plans. This individual will serve as the primary point of contact to manage contract negotiations with integrated health delivery systems, hospitals, local care units, physician practices, federally qualified health centers/community health centers, select ancillary providers, and other providers as required.

Key Responsibilities
  • Negotiate contractual arrangements with established and/or potential network providers, within budgeted targets, with approved contract guidelines and regulatory requirements.
  • Lead meetings between Point32Health and our provider network, effectively articulating Point32Health's position on key issues relevant to the contract negotiation.
  • Work closely with internal finance and actuarial teams to ensure data analytics and modeling are produced to support contract negotiations.
  • Develop contract documentation, clearly specifying terms, including legal, regulatory, policy, financial, and others, to ensure implementation of the contract and minimize/prevent internal/external misunderstandings of contract intent.
  • Collaborate with legal and compliance departments to ensure contract provisions are consistent across providers and include applicable legal and regulatory terms in the signed contract.
  • Develop and maintain effective working relationships with key counterparts representing the provider and internal colleagues to support Point32Health initiatives.
  • Understand important business aspects, such as unit cost trend, alternative payment methodologies, risk arrangements, medical loss ratio, provider financial performance, and analytical tools utilized by Point32Health to understand the performance, financial, and otherwise, of the provider network.
  • Lead and/or participate in cross-functional meetings as required, leading internal ad hoc groups to address contracting issues, communicate status of negotiations, and document key financial and legal terms.
  • Support submissions to government agencies specific to the Market.
  • Develop and maintain relationships with key providers supporting financial, clinical, sales, retention, and quality goals.
  • Be aware of network adequacy requirements for all Lines of Business and work to ensure adequacy and competitiveness in all provider networks.
  • Represent and speak for Network Contracting assigned Market, including with regional leadership, sales, clinical, marketing, and administrative colleagues, as well as with trade associations and regulatory agencies as required.
Qualifications
  • Bachelor's Degree or equivalent experience.
  • 5-7 years of work experience, preferred in managed care or other healthcare environment, with knowledge of the healthcare market and needs/concerns of the industry.
  • Direct contract negotiation for multiple lines of business and products is desirable. Understanding of provider payment methodologies and experience with risk-based financial models.
  • Must be an initiative-taking individual with excellent organizational skills to manage large volumes of information and multiple assignments; attention to detail is key.
  • Ability to understand and interpret the various aspects of a contract - financial, legal, and operational, with emphasis on implementation of contract terms.
  • Possess strong customer focus and expertise in setting and managing customer expectations.
  • Ability to understand the nuances of various product lines and the unique operational and financial features associated with each product.
  • Requires initiative, sound judgment, and ability to work independently under pressure in a constantly changing environment balancing multiple priorities.
  • Ability to learn and apply Point32Health Plans policies consistently and seek guidance when necessary.
  • Conceptualize and envision the impact of change and seek out efficiencies at work. Must be flexible and a proponent/champion of change.
  • Excellent people skills to develop strong working relationships with internal and external contacts.
  • Requires excellent diplomacy, oral and written communication skills, as well as the ability to coordinate efforts among various departments at Point32Health.
  • Ability to research, interpret, and communicate complex issues in a clear and succinct manner.
  • Advanced analytic ability with proficiency in Microsoft Word, Excel, and PowerPoint applications.
  • Must be able to work cooperatively as a team member.

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