Manager of Contracting at Boston

Job Summary:

The Manager of Contracting oversees strategic planning and implementation efforts necessary for successful development and management of cost-effective provider networks. He/she also leads network expansion initiatives in new geographic regions and for new lines of business as required.

Key Functions/Responsibilities:

• Manages Contract Managers in all aspects of provider network analysis, planning & implementation to ensure adequate access & availability of services to all BMCHP members;
• Works with key internal stakeholders (e.g., Medical Economics) to assess provider cost & utilization, and overall compliance with the terms of provider agreements;
• Oversees Contract Managers in negotiating financial and other contractual terms;
• Leads teams efforts in developing and implementing payment reform initiatives including, but not limited to financial risk arrangements, shared savings, pay-for-performance and other incentive programs as appropriate;
• Works with the Manager of Contracting Operations & Projects to ensure effective implementation of provider reimbursement and other contractual terms;

• Manages development, implementation and continuous improvement of departmental policies, procedures and workflows as required;

• Performs other duties as required to accomplish departmental and corporate goals and objectives;
• Regular and reliable attendance is an essential function of the position.

Supervision Exercised:

• Direct supervision of Contract Managers

Supervision Received:

• General supervision is received weekly from the Director of Contracting.

Qualifications:

Education:

• Bachelor’s degree in Health Care Administration, Business or related field, or an equivalent combination of education, training and experience required.

Education Preferred/Desirable:

• Master’s degree preferred

Experience:

• Four (4) or more years experience in provider contracting, provider relations, or operations, are required for individuals with a baccalaureate degree. A combination of six (6) years experience is required for individuals without a baccalaureate degree.
• Two (2) or more years in staff management is required.

Experience Preferred/Desirable:

Certification or Conditions of Employment:

• Pre-employment background check

Competencies, Skills, and Attributes:

• Ability to effectively lead, motivate and supervise professional staff;
• In-depth knowledge and understanding of all aspects of contracting finance including, but not limited to reimbursement methodologies and provider financial performance;
• In-depth knowledge and understanding of provider network operations and contract compliance;
• Strong financial analytical skills;
• Ability to assess provider network adequacy & lead strategic network development efforts;
• Ability to work collaboratively with key internal stakeholders at the leadership level to improve contracting compliance as appropriate;
• Knowledge of federal Medicare and Medicaid, and various state regulations, guidelines and standards;
• Effective communication (verbal and written) and relationship building skills;
• Expertise in Microsoft Office programs;

Working Conditions and Physical Effort:

• Work is normally performed in a typical interior/office work environment;
• No or very little physical effort required;
• No or very limited exposure to physical risk.

Country: USA, State: Massachusetts, City: Boston, Company: Boston Medical Center Healthnet Plan.