Director Network Contracting
CareCore National - Bluffton, SC

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Job Objectives : Oversees the healthcare delivery system contracting and contracting efforts for all new and managed networks. Responsible for the operations of the provider contracts department. Ensure that provider contracts are processed to support accurate and efficient claims payments. Oversees the formulation of provider contracts and specific terms to support the objectives of the specialty services area. Responsible for negotiating and providing cost effective agreements for customers. Oversees network reporting requirements to ensure compliance with regulatory agencies. Maintains positive relationships with provider network.

Responsibilities: Director, Provider Contracting Services (include, but are not limited to):
  • Responsible for developing the provider specialty networks through contract negotiations, relationship development, and servicing for large health systems and includes multiple provider types, ancillary, hospitals and physicians (not just one of these provider types).
  • Primary focus of this role is building networks, contracting and negotiating contract terms.
  • Serves in a leadership capacity, leading provider contracting service manager and department representatives, special projects/initiatives, or network planning.
  • Serves as a subject matter expert for local contracting efforts or in highly specialized in components of the contracting process and serves as subject matter expert for that area for a business unit.
  • Typically serves as lead contractor for large scale, multi-faceted negotiations. Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact.
  • May assist management in network development planning. May provide work direction and establish priorities for provider contracting services manager and team and may be involved in associate development and mentoring.
  • Works with the most complex providers. Complex providers may include, but are not limited to, institutional providers, large medical groups and ancillary providers, and providers in areas with significant competition. Contracts involve non-standard arrangements that require a high level of negotiation skills. Fee schedules are typically customized.
  • May work on projects impacting the business unit requiring collaboration with other key areas or serve on special projects around network management as needed.
  • May collaborate with sales team in making presentations to employer groups or account management in making presentations to client health plans.
  • Serves as a communication link between professional providers and the company.
  • Prepares financial projections and conducts analysis as required.
  • Performs other duties as assigned. Leads and directs the work of others

  • Minimum Requirements: Requires BA/BS and 8-10 years experience in contracting, provider relations, provider servicing or any combination of education and experience that would afford equivalent competencies. Experience must include current/prior healthcare provider contracting experience. Ancillary contracting experience strongly preferred. Must have exceptional oral and written communication skills and possess strong analytical skills. The position requires strong leadership and negotiation skills. The position requires travel (25 – 30%) and proficiency in using a personal computer and at minimum all Microsoft Office Programs.

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    Since 1994, CareCore National has provided comprehensive, customized programs to health plan clients that seek to manage appropriate...