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Manager, Network Contracting-IU Health Plans

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Company: Clarian Health Partners

Location: Indianapolis, IN

Date Posted: November 3, 2013

Source: Clarian Health Partners, Inc.

Job Details: Reporting to Director, Network Development., this position is responsible for negotiating contracts and overseeing relationships between the organization and providers to achieve desired business, financial and operational objectives. The incumbent is responsible, in collaboration with Director, for developing the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities.etc.) resulting in a geographically competitive, broad access, stable network that achieves objects for unit cost performance, trend management, and produces an affordable and predictable product for customers and business partners. Implements new contracts, develops and maintainsmanaged care contract databases and disseminates contract terms and requirements to operational areas. Establishes and coordinates a schedule for contract renewals. Working closely with Director and other members of the Network Management Team, develops and executes contracting strategy for specific products, providers and locations. , including renewal strategy, adhering to departmental pricing policy and preferred contract terms. Establishes working relationships with providers and effectively balances demands ...

Job Details: Reporting to Director, Network Development., this position is responsible for negotiating contracts and overseeing relationships between the organization and providers to achieve desired business, financial and operational objectives. The incumbent is responsible, in collaboration with Director, for developing the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities.etc.) resulting in a geographically competitive, broad access, stable network that achieves objects for unit cost performance, trend management, and produces an affordable and predictable product for customers and business partners. Implements new contracts, develops and maintainsmanaged care contract databases and disseminates contract terms and requirements to operational areas. Establishes and coordinates a schedule for contract renewals. Working closely with Director and other members of the Network Management Team, develops and executes contracting strategy for specific products, providers and locations. , including renewal strategy, adhering to departmental pricing policy and preferred contract terms. Establishes working relationships with providers and effectively balances demands of multiple contracts to assure timeliness, contract compliance and performance results. Works closely with Network Management Team, Operations Team and TPAs to identify and resolve issues and areas of concern. Monitors providers' business and marketing strategies and activities to assess potential impact or opportunity for the organization and recommend appropriate action.

QUALIFICATIONS/KNOWLEDGE/SKILLS/ABILITIES

* Bachelors degree required; Masters preferred (MHA, MSPH).
* Requires extensive experience ( 5 + years) with managed care contract negotiations involving physicians, ancillaries and hospital systems.
* Requires strong working knowledge of provider revenue and reimbursement.
* Requires strong working knowledge of Medical Expense Ratio.
* Requires expert level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
* Requires proven ability to develop functional, market level, and/or site strategy, plans, production and/or organizational priorities.
* Requires strong analytical skills and ability to exercise good judgment in complexities of the contract and relationship.
* Requires ability to maintain discretion and strict confidentiality of highly sensitive information pertaining to rates; legal action or other business strategies.
* Requires proven history of strong critical decision making skills and ability to respond quickly and efficiently to new projects and provider expansion requests.
* Requires knowledge of health care insurance industry and managed care industry practices.
* Requires ability to develop and maintain effective relationships - external and internal.
* Requires ability to plan; manage and operationalize to successful completion multiple projects at any given time.
* Requires highly effective verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others, including but not limited to reimbursement policy standards.
* Requires ability to interact effectively with multiple teams.

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