Senior Provider Network Contracting – Ltss

Senior Provider Network Contracting – Ltss

Requirements

• A minimum of 3 years experience negotiating contracts within the Medicaid line of business, specifically with Long Term Services and Support.
• Must reside in the state of Pennsylvania.
• Must be proficient in MS Office products.

Responsibilities

• Accountable for designing conceptual models, initiative planning, and negotiating high value/risk contracts with the most complex and challenging, market/region/national, largest group/system or highest value/volume of spend providers in accordance with company standards in order to maintain and enhance provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives.
• Drives or guides development of holistic solutions or strategic plans negotiates and executes contracts with the most complex, market/region/national, largest group/system or highest value/volume of spend providers with significant financial implications.
• Manages contract performance, and drives the development and implementation of value based contract relationships in support of business strategies. Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
• Accountable for cost arrangements within defined groups.
• Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
• Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives.
• Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.
• Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.
• Collaborates with internal partners to assess effectiveness of tactical plan in managing costs. May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

Preferred Qualifications

• Strong critical thinking, problem resolution, organization, communication, and interpersonal skills.
• Able to successfully manage multiple negotiations, issues, and other tasks to ensure completion and meet deadlines.
• Able to manage expectations and maintain strong relationships, both internally and externally.