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.
• 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.
• Responsible to address network leakage concerns for all clients.
• Bachelor's Degree with two or more years of experience or 4+ years of direct 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.