Reports To: Regional Director of Hospital and Physician Contracting
Manages: Contract Specialist
Purpose: To manage the development and implementation of hospital, provider and ancillary contracts for ConnectiCare, and assist in management of local provider units.
1. Manages higher cost and more complicated contracts (Tier I and Tier II) with the support of the Director.
2. Negotiates terms of contractual arrangements with physicians, hospital representatives and other providers. Negotiates rate renewals with provider representatives. Explains ConnectiCare contract and financial terms to contracting parties.
3. Manages contract administration through contract management tool, is a liaison for contract implementation with other contracting specialists. Communicates requirements to all affected parties. Understands ConnectiCare’s internal requirements and capabilities for contracting.
4. Understands delivery system needs. Creates hospital, ancillary, and physician contracts to meet those needs. Works with ConnectiCare departments to design new contractual arrangements, which secure ConnectiCare’s financial goals.
5. Works closely with delivery systems, Manager, Director and internal CCI departments to identify and evaluate new contracting opportunities for ConnectiCare and Affiliates.
6. Works with director to design payment systems, pay for performance mechanisms to ensure that proper incentives are created and provider unit plans financial targets are met.
7. Works with director to analyzes geographic needs, for physician services, and recruits providers of these services to ensure sufficient success and contracted rates for all services utilized/required through the network. Communicates with appropriate parties on network issues including representatives of the delivery system, Directors and Managers as necessary.
8. Participates in team meetings to review provider unit progress to budget targets and ensures issues are resolved. Functions as an active team member by communicating ideas, concerns and issues and using quality improvement techniques to improve provider unit performance.
9. Performs other related projects and duties as assigned.
10. Serves as resource and trainer for contract specialist team in all functional areas.
TECHNICAL KNOWLEDGE, EXPERIENCE AND SKILL REQUIREMENTS:
1. Bachelor’s Degree in the healthcare field.
2. At least 5 years of previous experience in a health care organization with a focus on contracting and financial analysis required, preferably working with customers/vendors.
3. Excellent oral and written communication and interpersonal skills required.
4. Excellent analytical skills required.
5. Knowledge of provider contracting financial arrangements and fee schedules, including understanding of health care reimbursement methodologies and guidelines preferred.
6. Excellent presentation skills required.
7. Experience in managing meetings.
8. Ability to lead team toward work processes and policy and procedures which are effective and efficient.
9. Must be able to travel within a defined geographic area.
1. Member and Customer Focus: Recognizes that members and customers (internal & external) are the driving force behind every business activity. Continuously makes an effort to exceed the expectations of members and customers.
2. Quality Orientation: Assumes responsibility for providing the highest level of quality to members and customers.
3. Innovation: The ability to see opportunities for change, to capitalize on them and implement them when appropriate for the benefit of ConnectiCare.
4. Communication: The ability to communicate with clarity both orally and in writing.
5. Teamwork: Demonstrates enthusiasm for the mission of ConnectiCare and inspires the same in others.
6. Results Orientation: The ability to break a complex problem down into its component parts and arrive at the appropriate solution in a timely fashion.
7. Change Mastery: Embraces change.
8. Learning Orientation: Assumes responsibility for personal and professional development.
ConnectiCare is an equal opportunity employer. M/F/D/V