Develop and maintain provider networks yielding a competitive, geographic, stable network that achieves objectives for unit cost performance and trend management. Produces an affordable and predictable network for customers and business partners. Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties. Performs other duties as assigned.
Key Accountabilities:- Develop and maintain provider network yielding a competitive, geographic, stable network that achieves objectives for performance and growth.
- Evaluates and negotiates contracts in compliance with company contract templates, and reimbursement structure standards.
- Builds and maintains positive relationships with providers.
- Processes and negotiates needed provider contract amendments and assignments as requested; and communicates contract terms and provisions to provider and all needed internal staff.
- Updates and maintains contract tracking system, records information sharing system and contracting calendar within contract metric timeframes.
Qualifications: - Bachelor's degree or equivalent experience in healthcare management/administration or healthcare related field
- Plus 3 years of work experience in health insurance/healthcare field
Skills and Abilities:- Strong knowledge of managed care products, e.g. HMO, POS, PPO and provider network administration
- Health plan negotiation experience preferred
- Expertise working with Microsoft Word, Excel, and Outlook
- Strong verbal and written communication
- High level of attention to detail and customer service
- Maintain regularly assigned work schedule
This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, St. Louis, MO, or Omaha, NE.
The full salary grade for this position is $70,200 - $120,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $70,200 - $105,315. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.
The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.
