Under the direction of the Manager, Allied Health Contracting, the Contract Manager, Allied Health Contracting negotiates and manages contracts with ancillary service providers in their assigned geographic region and network vendors with particularly complex provider and/or reimbursement issues. Key activities include, acts as point person for any large-scale provider recruitments and prioritizes providers targeted in disrupt communications or network gap analyses, determination of network needs, evaluation of prospective providers, development of reimbursement strategies, and contract negotiation and administration. The Contract Manager must maintain industry-specific knowledge and relationships with key providers and industry groups. This individual serves as a mentor and resource to Associate Contract Managers and Associate Contract Specialists on the team, and also may supervise 1-3 Associate Contract Managers or Associate Contract Specialists.
- Develops, negotiates, executes and manages provider contracts for services with complex provider and/or reimbursement issues. Participates in all operational aspects of contractual agreements. Develops and maintains key provider relationships.
- 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.
- 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 Allied Health Services in internal and external meetings. Prepares and delivers presentations to partner departments and industry forums.
- Serves as mentor and resource to Associate Contract Managers on team. May be required to directly supervise 1-3 Associate Contract Managers.
EDUCATION: (Minimum education & certifications required)
- Undergraduate degree required, with master's degree preferred
EXPERIENCE: (Years of experience)
- 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
SKILL REQUIREMENTS: (Include interpersonal skills)
- Effective communication and presentation skills, both verbally and in writing
- Contract negotiation experience is desirable, 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 ambiguous situations
- Proven time management and organizational skills, and ability to work independently and prioritize multiple demands
- Ability to understand the nuances of Tufts Health Plan's commercial and Medicare Preferred product lines and the unique operational and financial features associated with each
- Ability to lead and motivate others by fostering an attitude of cooperation and commitment, as well as capacity of liaison and negotiator
- Strong financial/analytical skills and problem-solving ability, with the ability to research, interpret, and communicate complex issues
- High degree of professionalism and confidence, including the ability to recognize politically sensitive issues, utilize diplomacy, and interact effectively with all levels of personnel
- Excellent computer skills, including proficiency in Microsoft Word, Powerpoint, and Excel
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel, overtime)
- Business professional environment. Periodic travel to local offsite locations.
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.
Please note: As of January 18, 2022, all employees - including remote employees - must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.
Point32Health is a leading health and wellbeing organization, delivering an ever-better health care experience to everyone in our communities. Building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, 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.
At Point32Health, we're working to reshape the world of health care by pushing past the status quo and delivering even more to the diverse communities we serve: more innovation, more access, more support, and healthier lives. And we want people like you on our side to make it even better.
This job has been posted by TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost 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: R5216