Description:
GENERAL SUMMARY
Responsible for network development, provider contracting, contract negotiations and coaching oversight to staff. Establishes and provides oversight of the department’s policies, procedures, and practices. Negotiates contracts, develops strategies and methodologies, contract terms, and alternatives for all contracts pertaining to fully insured, Health Plan, PPO, corporate accounts, lease networks, workers’ compensation, and behavioral health. Implements target cost savings initiatives for a broad base of provider and facility contracts.
ESSENTIAL RESPONSIBILITIES
- Implements development activities for a broad range of providers (facilities, labs, hospitals, etc.)
- Effectively works with plans to implement cost saving initiatives.
- Negotiates contracts; develops strategies and methodologies for specific initiatives and geographic areas.
- Recruits and contracts with individual providers.
- Assesses, develops, recruits, and organizes providers for all networks.
- Negotiates complex contracts with physician, ancillary, and hospital providers. Acts in an advisory capacity to the Legal Department with regard to the financial and legal impact of provider contract language requested.
- Serves as the entry point and system of checks and balances between network development and other corporate and plan departments for the purpose of reviewing significant provider contracts for all plans.
- Develops and provides plan support and contracting leadership, as required.
- Acts as a coach for network development initiatives.
- Compiles, maintains, and analyzes plans’ physician fee schedules including participating PCPs, participating specialists, and non-par physicians for the purpose of identifying cost savings opportunities.
- Compiles, maintains, and analyzes plans’ hospital rates for the purpose of identifying cost savings opportunities leading to local initiatives.
- Reviews and facilitates Requests for Proposals (RFPs) from ancillary providers whose services match a need for entering into a national or regional contract.
- Analyzes and recommends resolutions of contract barriers, taking into account prevailing local nuances.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Significant (7-10 years) experience in managed care.
- Significant (5-7 years) managed care contracting experience with a broad range of provider.
- Previous (3-5 years) management or project lead experience.
- Expert knowledge of provider contracting/negotiations, network development and configuration, standards for managed care delivery and cost containment programs.
- Substantive knowledge of managed care policy and direction.
- Strong communication and negotiation skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: Overland Prk, KS, US
Other Locations: ,
Organization: 13000 - CHC of Kansas
Schedule: Full-time
Job Posting: 2013-04-29 00:00:00.0
Job ID: 1311189
GENERAL SUMMARY
Responsible for network development, provider contracting, contract negotiations and coaching oversight to staff. Establishes and provides oversight of the department’s policies, procedures, and practices. Negotiates contracts, develops strategies and methodologies, contract terms, and alternatives for all contracts pertaining to fully insured, Health Plan, PPO, corporate accounts, lease networks, workers’ compensation, and behavioral health. Implements target cost savings initiatives for a broad base of provider and facility contracts.
ESSENTIAL RESPONSIBILITIES
- Implements development activities for a broad range of providers (facilities, labs, hospitals, etc.)
- Effectively works with plans to implement cost saving initiatives.
- Negotiates contracts; develops strategies and methodologies for specific initiatives and geographic areas.
- Recruits and contracts with individual providers.
- Assesses, develops, recruits, and organizes providers for all networks.
- Negotiates complex contracts with physician, ancillary, and hospital providers. Acts in an advisory capacity to the Legal Department with regard to the financial and legal impact of provider contract language requested.
- Serves as the entry point and system of checks and balances between network development and other corporate and plan departments for the purpose of reviewing significant provider contracts for all plans.
- Develops and provides plan support and contracting leadership, as required.
- Acts as a coach for network development initiatives.
- Compiles, maintains, and analyzes plans’ physician fee schedules including participating PCPs, participating specialists, and non-par physicians for the purpose of identifying cost savings opportunities.
- Compiles, maintains, and analyzes plans’ hospital rates for the purpose of identifying cost savings opportunities leading to local initiatives.
- Reviews and facilitates Requests for Proposals (RFPs) from ancillary providers whose services match a need for entering into a national or regional contract.
- Analyzes and recommends resolutions of contract barriers, taking into account prevailing local nuances.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Significant (7-10 years) experience in managed care.
- Significant (5-7 years) managed care contracting experience with a broad range of provider.
- Previous (3-5 years) management or project lead experience.
- Expert knowledge of provider contracting/negotiations, network development and configuration, standards for managed care delivery and cost containment programs.
- Substantive knowledge of managed care policy and direction.
- Strong communication and negotiation skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: Overland Prk, KS, US
Other Locations: ,
Organization: 13000 - CHC of Kansas
Schedule: Full-time
Job Posting: 2013-04-29 00:00:00.0
Job ID: 1311189