Jun 18, 2024

HP Sr Contract Manager

  • Professional Diversity Network
  • Canton, MA, USA
Full-Time Nurse

Job Description

Point32Health, Inc.

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. To learn more about who we are at Point32Health, click here.

Job Summary

The Senior Contract Manager, Ancillary Network Contracting, will be part of the Point32Health Ancillary Network Contracting team reporting to the Manager, Ancillary Network Contracting. Senior Contract Manager will operate with minimal oversite to manage ancillary specialties, for Harvard Pilgrim and Tufts Health networks for all lines of business. The Senior Contract Manager is responsible for provider specialties that are more complex in reimbursement, benefit application, and/or larger networks.

The Senior Contract Manager will function as point person for provider recruitments; determining network needs and evaluating prospective providers. The Senior Contract Manager will be responsible for working on contract negotiation and administration; adhering to plan reimbursement strategies. This individual will ensure that contract terms are consistent with the organization's established legal and financial guidelines. Additionally, the Senior Contract Manager will serve as a mentor; acting as a resource and assisting with training other team members. The Sr. Contract Manager will participate and will contribute to cross-divisional projects to ensure compliance and will collaborate on operational improvements and consistencies both internally and externally.

Key Responsibilities/Duties - what you will be doing

  • Develops, negotiates, executes and manages provider contracts for services and reimbursement issues with ancillary providers. Participates in all operational aspects of contractual agreements. Develops and maintains key provider relationships.
  • Effectively manages the enterprise contractual structure with providers across networks and lines of business. As well as represent the ancillary providers within the organization to include key network issues relevant to plan strategy and operations.
  • Collaborates with analytic staff to develop medical budget, evaluate cost trends, and formulate reimbursement models and/or program design. Monitors marketplace trends and new reimbursement methodologies. Is well versed in publicly reported data on reimbursement, market competitors, and regulatory requirements.
  • Evaluates the demand for assigned services and identifies areas of network deficiencies or increased service demand for network expansion. Determines the unique service capabilities of providers in the network. Designs and implements tools for communicating these capabilities to other departments and membership.
  • Identifies, evaluates, and implements new programs for improving medical cost management and/or administrative efficiency.
  • Represents Ancillary Network Contracting team in internal and external meetings. Prepares and delivers presentations with providers and to partner departments.
  • Maintains industry-specific knowledge and relationships with key providers and industry groups,
  • Other duties and projects as assigned.

Qualifications - what you need to perform the job

EDUCATION, CERTIFICATION AND LICENSURE:

  • Undergraduate degree required, with master's degree preferred

EXPERIENCE (minimum years required):

  • 5-7 years related experience in a managed health care environment, with a thorough knowledge of the health care market and the needs/concerns of health care providers
  • 3+ years of direct contract negotiation experience

SKILL REQUIREMENTS:

  • Contract negotiation experience with ability to understand and interpret all aspects of a contract: financial, legal, and operational with emphasis on implementation of contract terms.
  • High degree of initiative and result-orientation, and ability to deal effectively with conflict; demonstrating effectiveness, collaboration, flexibility, and innovation.
  • Strong knowledge of reimbursement methodologies financial/analytical skills and problem-solving ability, with the ability to research, interpret, and communicate complex issues.
  • Proven time management and organizational skills, and ability to work independently and prioritize multiple demands.
  • Excellent communication and presentation skills, both verbally and in writing.
  • Ability to lead and motivate others by fostering an attitude of cooperation and commitment, as well as capacity of liaison and negotiator.
  • High degree of professionalism and confidence, including the ability to recognize politically sensitive issues, utilize diplomacy, and interact effectively with colleagues at all levels.
  • Excellent computer skills, including proficiency in Microsoft Word, Excel, SharePoint and PowerPoint.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel):

  • 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.

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Compensation & Total Rewards Overview

As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

  • Medical, dental and vision coverage

  • Retirement plans

  • Paid time off

  • Employer-paid life and disability insurance with additional buy-up coverage options

  • Tuition program

  • Well-being benefits

  • Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do-from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's 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.

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