SummarySenior leader who provides strategic leadership and oversight for network management and contracting team. Develops and implements network strategies, manage provider contracts and negotiations, leads dispute resolution processes, and collaborates with key stakeholders to drive network growth and ensure high-quality provider relationships.
Duties And Responsibilities - Manages contract negotiations with Major Health Systems, large physician groups in West and North Texas; national ancillary providers; conducting several negotiations simultaneously to meet growth demands
- Deep understanding and experience with all complex contracts to ensure contract terms and conditions address the coding structures which are most impacted by negotiations
- People manager and mentor. Will directly manage a team of negotiators.
- Able to work in a fast-paced environment with high volume contracting requirements for the role. (Position will be responsible for completing a minimum number of contracts per month as well as managing the team to do the same.)
- Proactively build relationships that nurture provider partnerships to support the local market strategy
- Initiates, nurtures, and maintains effective channels of communication with matrix partners including, but not limited to, Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing
- Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position and identify and manage initiatives that improve total medical cost and quality; including renegotiation of existing agreements
- Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms
- Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities.
- Assists in resolving elevated provider service complaints, researching and negotiating with internal/external partners/customers to resolve complex and/or escalated issues.
- Manages key provider relationships and is accountable for critical interface with providers and business staff
- Coach and support newer team members on strategies and approaches to successful negotiations
- Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape
- Partner with Regulatory Affairs to ensure all network filings are timely and accurate; including participation with Compliance to ensure adherence to established guidelines supporting Mental Health Parity
Requirements - A minimum of 10 years professional work experience in provider negotiating and contracting with north Texas hospitals and/or affiliated large group contracting experience
- Bachelor's degree or equivalent experience in related field.
- Remote with occasional travel (5-10%)
- Existing relationships with major health systems and large physician groups in north Texas
- 7+ years of experience with health plan or provider organizations
- Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
- In depth understanding of the contract cycle from contractual negotiation to credentialing and contract terms load
- Hospital / Health Systems, Large Physician Groups and Ancillary provider contracting and negotiations
- Experience in developing and managing key provider relationships, including senior executives
- Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
- Team player with proven ability to develop strong working relationships within a fast- paced, high-volume organization
- Customer centric and interpersonal skills are required
- 5+ years of being a people manager
- Experience with Google products
Perks & Benefits - Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)
- $0 copays and $0 deductibles (with completion of our Baseline Visit )
- Preventive and primary care built in
- Mental health support (Rula, Televero, Two Chairs, Recovery Unplugged)
- One-on-one care navigation
- Chronic condition programs (diabetes, weight, hypertension)
- Maternity and family planning support
- 24/7/365 Curative Telehealth
- Pharmacy benefits
- Comprehensive dental and vision coverage
- Employer-provided life and disability coverage with additional supplemental options
- Flexible spending accounts
- Flexible work options: remote and in-person opportunities
- Generous PTO policy plus 11 paid annual company holidays
- 401K for full-time employees
- Generous Up to 8-12 weeks paid parental leave, based on role eligibility.
