Provider 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.
• Leverages market and service expertise to inform strategic initiatives, new product launches and provider-based partnerships.
• 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 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.
• 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 highly proficient in Microsoft Office.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.