Contract Manager

The Contract Manager will support all Lines of Business including Commercial, Senior Products and Public Plans by serving as the primary point of contact to manage contract negotiations with hospitals, physicians, community health centers and select ancillary providers and other providers as required.

The Contract Manager is responsible for the financial, regulatory, and legal terms negotiated with the provider network. The Contract Manager must be able to develop strategic proposals and contract with providers using appropriate reimbursement methodologies and their appropriate application. This includes but is not limited to Fee for Service, case rates, DRGs, APCs and EAPGs.

The Contract Manager must be able to transition the contract to applicable staff members for configuration and payment and may be required to participate in testing of the reimbursement structure.

In addition, this individual will ensure that contract terms are consistent with the corporate contracting strategy and are negotiated within the established legal, operational, and financial guidelines as established by Point32Health. This individual will assure than any non-standard elements of any contract negotiations have been properly researched, communicated and approved by key internal stakeholders. The Contract Manager must be able to effectively communicate the negotiated contract terms to downstream for accurate and timely implementation.

Key Responsibilities/Duties - what you will be doing

• Negotiate contractual arrangements with established or potential network providers, within budgeted targets, with approved contract guidelines and regulatory requirements.
• Working closely with internal finance and actuarial teams, provide direction to ensure data analytics are produced to support contract negotiations.
• Develop contract documents, to clearly specify terms, including legal, regulatory, policy, financial and other terms, which allow for implementation of the contract and minimizes or prevents internal and external misunderstandings of contract intent.
• Work closely with the legal and compliance departments to ensure contract provisions are consistent across providers and ensure all applicable legal and regulatory terms are included in the signed contract.
• Articulate to Network providers Point32Health's position on key issues relevant to the contract negotiation. Manage and position the negotiation so that Point32Health meets the key objectives that have been identified for the contracting cycle.
• Develop and maintain effective working relationships with key counterparts representing the provider and key internal colleague to allow for support of Point32Health initiatives.
• Understand, with a high degree of specificity, important business aspects such as global budget models, other alternative payment methodologies, unit cost trend, medical loss ratio, provider financial performance, and any analytical tools utilized by Point32Health to understand the performance, financial and otherwise, of the provider network. The Contract manager must be well versed in publicly reported financial data such as provider relative price, total medical expense, and hospital 403 cost information for use in negotiations
• Lead and/or participate in cross functional meetings as required; lead internal ad hoc groups to address contracting issues, communicate status of negotiations and document key financial and legal terms.
• As required support submissions to government agencies to either procure new business opportunities or to support retention of service lines and products.
• Develop and maintain relationships with key providers supporting financial, clinical, sales, retention, and quality goals. Participate as required in interdisciplinary teams engaged with key providers.
• Be aware of network adequacy requirements for all Lines of Business and work to ensure adequacy and competitiveness in all provider networks.
• Other duties as assigned.

Qualifications - what you need to perform the job

EDUCATION:

• Bachelor's Degree required.

EXPERIENCE:

• Preferred that the Contract Manager have a minimum of 3-5 years with more experience desirable, in a managed health care environment with a thorough knowledge of the health care market and the needs/concerns of health care providers.
• Direct contract negotiation for multiple lines of business and products is highly desirable. Understanding of payment methodologies and experience with risk based financial models is strongly preferred.

SKILLS/ABILITIES:

• Excellent communication, presentation and influencing skills
• Demonstrated initiative
• Demonstrated strength in finance to support and master financial contract components and analysis and ability to synthesize results to make sound recommendations
• Ability to work independently
• Ability to effectively manage competing priorities and succeed in a changing, highly results oriented, deadline driven environment
• Ability to research, interpret and communicate complex issues in a clear and succinct manner
• Advanced analytic ability with proficiency in Microsoft Word, Excel, and PowerPoint applications
• Advanced ability to create Power Point slide decks which relate visually clear, succinct, and targeted messages to various audiences
• Ability to communicate effectively with physician leaders and high-level hospital administrators

Working Conditions and Additional Requirements:

• Some regional travel required

Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do-from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID: R5961

About the Company:
Point32Health