Job Summary
With minimal direction, acts as the key contact and subject matter expert for all contract-related activities. This includes developing and negotiating contract terms, conditions, modifications, penalties and incentives, while working with key stakeholders to ensure that their requirements are met. Analyzes and evaluates change to drive continuous improvement in the process of contract management and contract management trends. Leads the proactive, methodical management of contracts from initiation through execution, compliance and renewal. Provides support for management of medical cost of care and efficiency initiatives. Additionally, this position manages the contract execution process, resolving problems, mitigating delays, mediating disputes and escalating issues. Staff members in this position are effective and self-sufficient in working within a diverse selection of contracts and providers. Regularly provides guidance and training to less experienced Specialists.
Essential Functions
Manages the contract development and negotiations process for provider networks initiatives. Enters/maintains current information in the internal contract repository and system contract database.
Create and executive network development plans and deploy strategies to move providers to desired contract terms according to guidelines and standards. Provide effective oversight of contract implementation process ensuring all contracts are within required guidelines and financial parameters.
Act as the principle contract negotiator for all assigned contracts. Manages contract review meetings to ensure delivery against objectives and contract budgets; develops regular reports on contract milestones and performance; and informs internal customers of activities and progress, through both verbal and written communications.
Interface routinely with hospital, PHO, and PO leadership on an independent basis while understanding other political sensitivities of assigned groups.
Work with and involve relevant stakeholders (internal customers) as needed in negotiation decisions impacting legal or regulatory requirements, contract standards, cost target and payment and pricing methodologies. Facilitate contract implementation process with the PIM team, including payment rates, PFP/PHO groupings, risk poll assignment, administration and other fees. Work collaboratively with PIM and other internal staff to find solutions to provider issues concerning payment and operation procedures, etc, when necessary.
Creates a customer-focused, service-based approach to working with stakeholders which emphasizes the creation and cultivation of cross-organizational relationships.
May represent contracting at external and Joint Operating Committee meetings. May oversee development and implementation of network expansion and individual physician recruitment within an assigned geographic area. May be requested to present and represent Provider Network Contracting at meeting with external constituencies.
Provides mentoring to less experienced team members, and is accountable as a role model for customer service excellence.
Qualifications
Required Bachelor's Degree or equivalent Bachelor's Degree in business administration, health care administration, psychology, finance, health and human services
Preferred Master's Degree Masters Degree in business administration, health care administration, finance, health and human services
5 years of relevant experience Negotiating and managing contract lifecycles on behalf of either third party payers or health care providers Required
7 years of relevant experience Proven experience leading negotiations directly and independently or leading a provider contracting team in negotiations. Required
Experience in finance or contract management and knowledge of CMS and commercial pricing practices and methodologies Required
Experience working with legal staff Preferred
Skills in best practices for contract negotiation tactics and strategies Preferred
Working knowledge of anti-trust laws Preferred
Physical Demands
Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
Waist to Waist > 5 lbs: Seldom up to 10 lbs
Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
Waist to Overhead > 5 lbs: Seldom up to 10 lbs
Bilateral Carry > 5 lbs: Seldom up to 10 lbs
Unilateral Carry > 5 lbs: Seldom up to 10 lbs
Pushing Force > 5 lbs: Seldom up to 10 lbs
Pulling Force > 5 lbs: Seldom up to 10 lbs
Sitting: Frequently
Standing: Occasionally
Walking: Occasionally
Forward Bend - Standing: Seldom
Forward Bend - Sitting: Occasionally
Trunk Rotation - Standing: Seldom
Trunk Rotation - Sitting: Occasionally
Reach - Above Shoulder: Seldom
Reach - at Shoulder or Below: Seldom
Handling: Occasionally
Forceful Grip > 5 lbs: Seldom
Forceful Pinch > 2 lbs: Seldom
Finger/Hand Dexterity: Frequently
Primary LocationSITE - Corewell Health Place Building B - 648 Monroe - Grand Rapids
Department NameManaged Care Contracting
Employment TypeFull time
ShiftDay (United States of America)
Weekly Scheduled Hours40
Hours of Work8:00 a.m. to 5:00 p.m.
Days WorkedMonday to Friday
Weekend FrequencyN/A
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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella,... For full info follow application link.
Beaumont Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity, sexual orientation, age, status as a protected veteran, or status as a qualified individual with a disability.
