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Job Description
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 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 experience typically gained through skills/knowledge/abilities Negotiating and managing contract lifecycles on behalf of either third party payers or health care providers Required
7 years of experience typically gained through skills/knowledge/abilities 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
Primary Location
SITE - Priority Health - 1231 E Beltline - Grand Rapids
Department Name
PH - Provider Contracting Ancillary
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8a-5p
Days Worked
M-F
Weekend Frequency
N/A
Spectrum Health requires all team members to receive the COVID-19 vaccinations subject to certain exclusions based on the team member's job category. Spectrum Health is committed to granting reasonable accommodations in accordance with applicable laws.
Accommodation Notice: If you are a qualified individual with a disability, you may request a reasonable accommodation in Spectrum Health's application process. Contact us at 616-486-SHHR (7447).
Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected
category. See more here (https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf) .
Spectrum Health requires all team members to receive the COVID-19 vaccinations subject to certain exclusions based on the team member's job category. Spectrum Health is committed to granting reasonable accommodations in accordance with applicable laws.
Who We Are
Spectrum Health is a nationally recognized not-for-profit health system, offering a full continuum of health services through our health plan, medical group and hospital group. As an integrated health system, we are able to work together across all facilities, employees and providers to create exceptional, consumer-focused interactions.
Spectrum Health is redefining what it takes to improve the health of our communities and introducing new and innovative ways for consumers to access high-quality, low-cost care so that they can connect with us for a lifetime of health.
We strive to provide one Spectrum Health experience: a consistent, high-quality, seamless health journey for consumers; no matter where, when or how they interact with us. The result is better health outcomes for the thousands of individuals, families and communities we serve.
We are the region's largest employer, with corporate offices located in Grand Rapids, Michigan. Spectrum Health Hospital Group and Spectrum Health Medical Group are consistently recognized for the exceptional care they provide. Priority Health is among the largest health system-sponsored health plans in the U.S. and offers extensive experience serving large and small employer groups, individuals, Medicare Advantage, Healthy Michigan Plan and Medicaid populations.
Since 2010, Spectrum Health has been listed five times among the 15 Top Health Systems in the U.S. by Truven Analytics™. Click here (https://www.spectrumhealth.org/about-us/quality-safety-and-patient-experience/awards) to see a complete list of our safety, quality and patient experience awards.