Senior Contract Manager
- Portland, ME
The Senior Contract Manager will support all Lines of Business, including Commercial, Senior Products and Public Plans as applicable to the Maine Market. The Senior Contract Manager 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.
The Senior Contract Manager is responsible for the financial, regulatory, and legal terms negotiated with the provider network. The Senior Contract Manager must be able to develop strategic proposals and contract with providers using appropriate reimbursement methodologies and their appropriate application.
In addition, the candidate will ensure that contract terms are consistent with the corporate contracting strategy and are negotiated within the established legal, operational, and financial guidelines as established by Point32Health. This individual will assure than any non-standard elements of contract negotiations are thoroughly researched, communicated and approved by key internal stakeholders. The Senior Contract Manager must be able to effectively communicate the negotiated contract terms to stakeholders for accurate and timely implementation.
Key Responsibilities/Duties – what you will be doing
- 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, while effectively articulating Point32Health's position on key issues relevant to the contract negotiation. Manage and position the negotiation so that Point32Health meets the key objectives that have been identified for the contracting cycle.
- Work closely with internal finance and actuarial teams, while providing direction 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 thus allowing for implementation of the contract and minimizing/preventing internal/external misunderstandings of contract intent.
- Work closely with legal and compliance departments to ensure contract provisions are consistent across providers and ensure applicable legal and regulatory terms are included in the signed contract.
- Manage and position the negotiation so that Point32Health meets the key objectives that have been identified for the contracting cycle.
- Develop and maintain effective working relationships with key counterparts representing the provider and key internal colleagues to allow for support of Point32Health initiatives.
- Understand, with a high degree of specificity, important business aspects such as alternative payment methodologies, unit cost trend, medical loss ratio, provider financial performance, and any analytical tools utilized by Point32Health to understand the performance, financial and otherwise, of the provider network. The Senior Contract manager must be well versed in publicly reported financial data, such as provider relative price and total medical expense, for use in negotiations.
- Lead and/or participate in cross functional meetings as required - lead internal ad hoc groups to address contracting issues, communicate status of negotiations and document key financial and legal terms.
- As required, support submissions to government agencies specific to your Market.
- Develop and maintain relationships with key providers supporting financial, clinical, sales, retention, and quality goals. Participate as required in interdisciplinary teams engaged with key providers.
- 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 in the Maine Market, including with regional leadership, sales, clinical, marketing and administrative colleagues, as well as with trade associations and regulatory agencies as required.
- Other duties as assigned.
Qualifications – what you need to perform the job
- Bachelor’s Degree or equivalent experience.
- 5-7 years’ work experience, preferred in managed care or other health care environment, with knowledge of the health care 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 is preferred.
- Must be 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 Plan’s 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.
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS:
- Must be able to work under normal office conditions and work from home as required.
- Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
- May be required to work additional hours beyond standard work schedule.
Commitment to Diversity, Equity & Inclusion
Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Who We Are
Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities.
This job has been posted by IGNYTE AI on behalf of Point32Health. IGNYTE AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of IGNYTE AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.
Req ID: R7049
Tuesday, September 19, 2023