Director of Contracting and Provider Relations - Managed Care

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Position Purpose

Coordinate, negotiate and handle activities of the provider contracting and relations function and aid in formulating and administering organizational policies and procedures. Negotiate large hospital, physician groups and ancillary service agreements and overseeing external customer service for providers in accordance with Corporate, health plan and government regulations and guidelines.

Position Responsibilities

  • Support provider contracting and relations activities to ensure efficiency and maintain compliance with Company policies and standards, government laws and regulations.
  • Negotiate contracts with hospitals, physician groups and ancillary service agreements
  • Develop and implement a network development plan for the assigned region and set of providers and identify and initiate contact with potential providers in support of the Company's strategic goals and objectives.
  • Effectively integrate new programs and strategies to reach per member per month targets, and provide oversight to the provider set-up and contract configuration in the computer system to ensure accurate claims adjudication.
  • Perform basic financial analyses to identify medical cost improvement opportunities, develop strategies to reach financial goals, and execute contracting strategies to meet goals and objectives.
  • Evaluate and monitor providers' performance standards and financial performance of contracts.
  • Develop staff skills and competencies through training and experience.

    • Knowledge/Experience

    Bachelor's Degree or equivalent in business administration, health care administration or related area. 5–7 years of related experience negotiating hospital, large physician groups and ancillary service agreements and external customer service for providers. Experience in claims processing, marketing/sales, medical economics in a managed care or insurance environment.

    Jason Edwards

  • 411.2228 x 200 Toll Free
  • 982.7508. Fax
    Jason@NurseResolutions.com
    www.NurseResolutions.com

    contracting, contracts, provider relations, network development, claims, providers, managed care, billing, managed care, medicaid, mco, analyst, contracting, provider relations,


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