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Contract Manager Jobs

Company

Point32Health
Address , Canton
Employment type FULL_TIME
Salary
Expires 2023-11-30
Posted at 9 months ago
Job Description
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. To learn more about who we are at Point32Health, click
here
.
Job Summary
Under the direction of the Point32Health Manager, Ancillary Network Contracting, the Contract Manager, Ancillary Network Contracting negotiates and manages contracts with behavioral health ancillary providers and with particularly complex provider and/or reimbursement issues. Key activities include recruiting non participating providers, determination of network needs, evaluation of prospective providers, development of reimbursement strategies, and contract negotiation and administration. The Contract Manager must maintain industry-specific knowledge and relationships with key providers and industry groups. This individual serves as a mentor and resource to Associate Contract Managers on the team.
Key Responsibilities/Duties – what you will be doing
KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS* (in order of importance)
Evaluates the demand for assigned services and identifies areas of network deficiencies or increased service demand for network expansion. Recruits and contracts non-participating behavioral health providers to create a robust network across the enterprise. Determines the unique service capabilities of providers in the network. Designs and implements tools for communicating these capabilities to other departments and membership.
Develops, negotiates, executes and manages provider contracts for services with complex provider and/or reimbursement issues. Participates in all operational aspects of contractual agreements. Develops and maintains key provider relationships.
Collaborates with analytic staff to develop budget, evaluate cost trends, and formulate reimbursement models and/or program design. Monitors marketplace trends and new reimbursement methodologies.
Identifies, evaluates, and implements new programs for improving medical cost management and/or administrative efficiency.
Represents Ancillary Network Contracting in internal and external meetings. Prepares and delivers presentations to partner departments and industry forums.
Serves as mentor and resource to Associate Contract Managers on team. May be required to directly supervise 1-3 Associate Contract Managers.
Qualifications – what you need to perform the job
EDUCATION: (Minimum education & certifications required)
Undergraduate degree required, with master’s degree preferred
EXPERIENCE: (Years of experience)
5-7 years related experience in a managed health care environment, with a thorough knowledge of the health care market and the needs/concerns of health care providers
SKILL REQUIREMENTS: (Include interpersonal skills)
  • Proven time management and organizational skills, and ability to work independently and prioritize multiple demands
  • Excellent computer skills, including proficiency in Microsoft Word, Powerpoint, and Excel
  • Contract negotiation experience is desirable, with ability to understand and interpret all aspects of a contract: financial, legal, and operational with emphasis on implementation of contract terms
  • High degree of initiative and result-orientation, and ability to deal effectively with ambiguous situations
  • High degree of professionalism and confidence, including the ability to recognize politically sensitive issues, utilize diplomacy, and interact effectively with all levels of personnel
  • Ability to lead and motivate others by fostering an attitude of cooperation and commitment, as well as capacity of liaison and negotiator
  • Strong financial/analytical skills and problem-solving ability, with the ability to research, interpret, and communicate complex issues
  • Ability to understand the nuances of Tufts Health Plan’s commercial and Medicare Preferred product lines and the unique operational and financial features associated with each
  • Effective communication and presentation skills, both verbally and in writing
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel,
overtime)
Business professional environment. Periodic travel to local offsite locations.
CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.
  • Essential functions occur simultaneously, therefore, the employee must be able to appropriately handle each essential function, prioritize them and seek assistance when necessary. These functions need to be performed on a consistent and regular basis, using good judgment. Ability to learn and apply company policies consistently, seeking out guidance when necessary, is required.
THIS DESCRIPTION IS NOT INTENDED TO BE A COMPLETE STATEMENT OF JOB CONTENT; RATHER IT ACTS AS A GUIDE TO THE ESSENTIAL FUNCTIONS PERFORMED. MANAGEMENT RETAINS THE DISCRETION TO ADD TO OR CHANGE THE DUTIES OF THE POSITION AT ANY TIME.
Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity
Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's 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.