Job DescriptionResponsible for the development and maintenance of the Network Plan the provider handbook, for evaluation of the adequacy of the network, for assuring that the network meets URAC and DoD standards, and that there is compliance with all elements of the TRICARE Management Activity contract. Understands the attitudes and values of the community and establishes effective working relationships with stakeholders to increase resources and collaboration. Acts as a representative and spokesperson for US Family Health Plan both internally and externally. Responsible for assuring providers and network members are educated in Health Plan criteria and processes. Responsible for the non-clinical utilization management functions of the Health Plan. Responsible for compliance with the DoD contract regarding network and utilization issues. Responsible for a key role in provider contracting and network relations.
Leads contract negotiations for acceptable reimbursement terms and contract language with all network providers across the continuum of care. (i.e. hospitals, physician groups and ancillary services). Will conduct negotiations and complete the contracting process in a timely manner in accordance with USFHP contracting principles, organizational policies and procedures and all elements of the TRICARE Management Activity contract.
Required qualifications:- 5 years of Managed care operations.
- Extensive experience and understanding of capitated medicine, contracted networks and health plan contracts.
Preferred qualifications:- Bachelor's Degree in related field
- Ambulatory medicine.
- Project management.
- Contract negotiation.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
About the TeamPacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with outpatient clinics and primary and specialty care providers in King, Snohomish and Pierce counties. We combine decades of patient-centered care with cutting-edge technology, first-class facilities and board-certified providers.
Our strong team environment and respect for our people-at all levels and from all backgrounds-allow us to provide authentic care that achieves the highest-quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Health Services.
