Manager, Provider Network Contracting & Relations

About the Company

Responsibilities

• ● Leads complex contracting and reimbursement negotiations, including outreach and contract negotiations with provider network and vendors.
• ● Oversee the contract lifecycle including loading, submissions, and coordination with matrix partners for network implementation and maintenance.
• ● Ensure that contracts comply with DHS and CMS regulations.
• ● Ensures departmental compliance with provider roster and credentialing requirements .
• ● Monitors contracts, enforces contract terms, and ensures renewals and amendments are completed in a timely manner.
• ● Manage network adequacy in alignment with business needs and regulatory guide lines.
• ● Leads contract onboarding and education on CEI/PACE requirements.
• ● Monitors contract performance and support timely issue resolution .
• ● Oversee the finalization of Letters of Agreement and Memoranda of Understanding.
• ● Prepares, analyzes, reviews, and projects the fiscal impact of complex contracts, including value-based care and alternative payment arrangements.
• ● Updates the Provider Manual annually .
• ● Overseas the accuracy of contracting and purchasing software systems.
• ● Develops and implements departmental policies and procedures.
• ● Monitors and reviews departmental duties, compliance, and workflow to ensure policies are implemented with the highest level of efficiency and accuracy.
• ● Perform supervisory duties, including interviewing, hiring, training employees, assigning work, and supporting staff development.
• ● Evaluates the performance of direct reports, recommends training, and maintains staff at the level of skill necessary to meet organizational objectives.
• ● Build relationships that support external and inte rnal partnerships and identifies broader business opportunities that advance the organization's strategy.

Requirements

• ● Requires a bachelor's degree in health care administration, business administration, finance, public administration, or a related field.
• ● Requires five years of experience in contract negotiations, fiscal management , or a related field.
• ● Supervisory or leadership experience preferred.
• ● Req uires knowledge of Medicare, Medicaid, and commercial reimbursement practices, as well as three years of experience in physician, health care, and vendor contract negotiation and administration.
• ● Requires familiarity with terms and conditions for services and in-depth knowledge of legal terminology.
• ● Knowledge of ICD-9, ICD-10, CPT, and HCPCS codes is preferred.
• ● Demonstrates an elevated level of diligence and attention to detail.
• ● Proficient in Microsoft Office, including Excel, Word, and PowerPoint; experienc e with contract management software is preferred.
• ● Demonstrates excellent written and verbal communication skills, with the ability to communicate clearly, concisely, and effectively at all levels of the organization.
• ● Demonstrates the ability to plan, organize, and meet deadlines while managing numerous and changing priorities.
• ● This job description is intended to communicate the general functions of the position and is not intended to be an exhaustive or complete outline of all tasks and responsibilities th at may be required. CEI reserves the right to modify job descriptions, site assignments, and / or work hours based on the needs of the program. All employees are expected to perform their duties to the best of their abilities and as required by the position and/or requested by management.
• ● Placement within the compensation range listed here is determined by job-related qualifications, experience, internal equity, and market factors, consistent with CEI compensation practices. Salary Range 135,937 - 164,413 USD