SummaryThe Senior Contracting Specialist oversees the development and management of insurance networks, focusing on improving affordability and quality outcomes while managing provider relationships and negotiation strategies in their specified region.. This role is crucial for building and maintaining a strong network of healthcare providers, ensuring access to care for members, and optimizing network performance. Candidates should have experience working with providers in their specified region states.
Duties And Responsibilities - Manages increasingly complex contract negotiations with hospitals and other providers for Commercial product lines (e.g., Hospital systems, Ancillaries, and large physician groups).
- Proactively builds 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.
- Supports and provides direction to develop network analytics required for the network solution.
- Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position.
- Identify and manage initiatives that improve total medical cost and quality.
- Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.
- Assists in resolving elevated and complex provider service complaints. Research problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.
- Manages key provider relationships and is accountable for critical interface with providers and business staff.
- 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.
QualificationsTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
- Bachelor's degree or equivalent experience in related field, including 7+ years Contracting and Negotiating experience involving complex delivery systems and organizations required
- Experience with Physician, Hospital and Ancillary group contracting and negotiations
- Experience negotiating delegated and capitated agreements
- Experience in developing and managing key provider relationships including senior executives
- Knowledge of complex reimbursement methodologies
- Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
- Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models
- Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization
- The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations
- Customer centric and interpersonal skills are required
- Superior problem solving, decision-making, negotiating skills, contract language and financial acumen
- Remote with occasional travel (5-10%)
- 10 years of contract negotiation experience
- Negotiate competitive managed care agreements with complex providers, including hospital systems, PHOs, and large IPAs.
- Existing relationships with hospitals in the West market(s) will be helpful
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.
