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Contract Manager I

Contract Manager I

Job ID 
2017-4352
Job Locations 
US-FL-Tampa
US-CT-Hartford
US-AZ-Phoenix
Category 
Provider/Network Management

More information about this job

Overview

Network Contract Managers drive all aspects of provider network management for an assigned geographic area, typically comprised of various states. Not the typical Network Management role, the Managers function like P&L leaders as they have direct responsibility over Gross Margin which impacts CCX’s profitability (and resulting EBITDA). Serving as the face of CCX to our providers, Managers negotiate contracts (rates & terms), drive in-network utilization by ensuring adequate provider depth (coverage area) and breadth (line of business), and ensure high levels of provider satisfaction by treating CCX network providers (our key asset) as a client.

Responsibilities

• Initiates, develops and manages provider contracts and senior-level provider relationships.
• Understands and knowledgeable of the contract templates, and applicable regulations surrounding network administration and claims payments.
• Understand and knowledgeable of individual provider contracts
• Monitors and documents contract compliance via metrics to to ensure delivery of agreed upon terms by the provider to CareCentrix
• Monitors, identifies, escalates , and takes action on identified deficiencies in contract performance and takes action to correct any gaps / deficiencies in quality or financial performance.
• Build a deep localized knowledge base to inform strategic planning.
• Build strong relationships with providers to ensure lines of communications are open and strong.
• Leverages market and service expertise to inform strategic initiatives, new product launches and provider-based partnerships.
• Participates in strategic and tactical initiatives led by the Network Management department
• Collaborates and works well within both the Network Management team and other departments.
• Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills.
• Manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.
• Accountable for assuring appropriate access to services in assigned geography
• Accountable for gross margin targets in assigned geography
• Accountable for network QUALITY – monitoring and enforcing contract terms, administering corrective action plans and coordinating audit activities.
• Responsible for negotiation of individual provider contracts with goal of managing to our “standard template terms”.
• Responsible for securing appropriate med-econ and legal approval for negotiations outside of the terms.
• Responsible to address network leakage concerns for all clients.
• Responsible for coordinating CCX communications with the provider.
• Responsible for maintaining current contact list is CCX standard format / systems.
• Responsible for maintaining current service code / zip code information for providers.
• Responsible to facilitate with the credentialing team and the onboarding team to ensure positive provider experience.
• Responsible for following or standard fee schedule update process and for assuring accuracy of same.

Qualifications

• Bachelor’s Degree with four or more years or 6+ years comparable healthcare experience in provider contract or relationship management required.
• Must be familiar with modern office equipment and must be highly proficient in Microsoft Office.
• Requires rigorous critical thinking and independent judgment

 

CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.