Provider Contract Manager

Job Summary:

The Provider Contract Manager supports the Director, Provider Contracting & Strategic Growth with the development, implementation, and management of provider contracting operations processes.

Essential Functions:

• Ensure operational effectiveness by assisting in strategic and business planning, including strategic initiative identification and resource planning and allocation
• Partner with leadership to determine and prioritize opportunities to achieve departmental and enterprise goals
• Participate in provider contract template development
• Provide proactive support, oversight, and management of Preferred, Acceptable, Discouraged, and Unacceptable (PADU). tool and Contract Review Committee (CRC)
• Collaborate with internal business areas on contract negotiations to understand and mitigate operational impacts
• Act as a provider contract management system subject matter expert including but not limited to facilitating user training, contract template management, system troubleshooting, and business requirements
• Facilitate in the development, implementation, and monitoring of departmental policies and procedures
• Support activities as assigned in relation to business development
• Recognize and proactively manage operational dependencies and risks across strategic initiatives and process improvements
• Participate in the process of estimating initiative budgets as well as developing business cases and tracking the benefits realization
• Develop and maintain an in-depth knowledge of the company’s business and regulatory environments
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is required
• Master’s Degree or equivalent work experience is preferred
• Minimum of three (3) years of healthcare experience, to include one (1) year of work experience in managed care provider relations or provider contracting
• Minimum of three (3) years of experience in leading business initiatives to drive systemic change is preferred
• Managed care experience is highly preferred

Competencies, Knowledge and Skills:

• Proficient in Microsoft Office Suite (Outlook, Teams, Word, Excel, PowerPoint, and SharePoint). Experience with Visio is a plus
• Effective identification of business problems, assessment of proposed solutions to those problems, and understanding of the needs of business partners
• Advanced-level knowledge of provider contracting processes and operations
• Working knowledge of complex provider organizational structures including but not limited to Accountable Care Organizations (ACOs), Clinically Integrated Networks (CIN), and Independent Practice Associations (IPAs). Excellent written and verbal communication and interaction skills
• Effective problem-solving, critical thinking, and listening
• Ability to manage and prioritize multiple tasks, promote teamwork and fact-based decision making

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Perform reasonable travel, up to 15% to fulfill the duties of the position

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.