Health Plan Provider Contracts Manager - Complex
On-siteBoston, Massachusetts, United States
Job Summary
Negotiate complex provider contracts and letters of agreement with hospitals, hospital systems, and behavioral health organizations to secure high-quality, cost-effective network members. Execute standardized alternative payment model (APM) contracts, manage value-based payment methodologies, and optimize provider relationships to reduce member access grievances and improve the medical cost ratio. Direct analysis of financial impacts for executive approval on agreements outside standard guidelines while maintaining contractual relationships with significant providers. Assess contract language for regulatory compliance, participate in fee schedule determinations, and educate internal customers on payment structures. Travel approximately 5-10% within designated Massachusetts regions to support network adequacy and strategic goals.
Required Qualifications
- At least 5 years of experience in network contracting with large specialty or multispecialty provider groups
- At least 3 years experience in provider contract negotiations in a managed health care setting
- Experience negotiating different provider contract types (i.e. physician/group/hospital)
- Working familiarity with various managed health care provider compensation methodologies
- Experience primarily across Medicaid and Medicare lines of business
- Experience with value-based payment (VBP)
- Experience with fee-for service (FFS)
- Experience with capitation
- Experience with various forms of risk
- Negotiation and relationship building capabilities
- Ability to navigate complex regulatory environments
- Data-driven decision-making skills
- Analytical abilities
- Organizational skills
- Attention to detail
- Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization
- Ability to manage multiple tasks and deadlines effectively
- Effective verbal and written communication skills
- Microsoft Office suite proficiency
- Applicable software programs proficiency
- Travels approximately 5-10% within designated Massachusetts regions
Desired Qualifications
- Contracting experience with integrated delivery systems, hospitals and groups (specialty and ancillary)
- Experience with Medicaid, Medicare, and Marketplace government-sponsored programs
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