- Organizational Skills
- Microsoft Powerpoint
The position of Senior Contract Manager within the Network Contracting and Performance Management department for Senior Products serves as the primary point of contact with provider organizations to negotiate and manage contracts with network physicians and hospitals. This individual is the primary lead during negotiations and is accountable for the financial and legal terms negotiated with the provider organizations. This individual will assure that contract terms are consistent with the corporate and Senior Products contracting strategies, and are negotiated within the established legal and financial guidelines as established by Tufts Health Plan. This individual will assure that any non-standard elements of any contract negotiation have been properly researched and communicated to key internal stakeholders. This individual also will coordinate with the appropriate personnel from the Provider Engagement and Implementation team to oversee the successful implementation of contract terms within the organization's system and processes.
In addition, the Senior Contract Manager is responsible for assisting with training and for leading projects within the department. The individual will mentor, guide and support staff within the department to help assure the successful achievement of business and professional goals. This may include, but is not limited to, reviewing contracts and/or developing contract templates, providing guidance on contracting strategies, and facilitating a resolution to complex financial, legal, compliance, reporting or implementation challenges. Should there be a business need for this individual may manage direct reports, they will be expected to provide coaching, feedback and direction to staff to assure the successful achievement of business and professional goals. This includes developing recruitment and retention plans for such individual(s).
The Senior Contract Manager will also provide support to the Director in developing contracting strategies to accommodate the ever changing Medicare Advantage market, including exploring new product offerings, potential network expansion/development and alternative contracting models. This individual will represent Provider Contracting in both internal and external meetings specific to contracting related interests as they apply to Clinical Services, Risk Adjustment, Actuarial services, Claims and Sales within the Senior Division or enterprise wide functions if applicable.
Essential functions occur simultaneously. The employee must be able to appropriately handle each essential function, prioritize with minimal direction, and seek assistance when necessary. These functions need to be performed on a consistent and regular basis, using good judgment.
1. Negotiate contractual arrangements with established or potential network providers for the Senior product lines, within budgeted targets and regulatory requirements. Direct analyses to support contract negotiations, oversee the development of contract documents, and summarize contractual terms, legal and financial, for implementation by the Provider Performance Management and Implementation area.
2. Lead Senior Leadership meetings between THP and our provider network. Effectively articulate to THP's position on key issues relevant to the contract negotiation. Manage and position the negotiation so that THP meets the key objectives that have been identified for the contracting cycle.
3. Work closely with the legal and compliance departments to assure contract provisions are consistent across providers and assure all applicable legal terms are included in the signed contract.
4. Summarize and document any non-standard elements of the negotiations. Communicate results to applicable internal departments.
5. Understand, with a high degree of specificity, important business aspects such as Medicare and Medicaid rules and regulations, reimbursement methodologies, claims trend, provider/TMP financial performance, and any analytical tools utilized by THP to understand the performance, financial and otherwise, of the provider network.
6. Lead and/or participate in cross functional projects and meetings to support key business initiatives (such as managing Senior Division projects related to specific contracting strategies, facilitating internal ad hoc groups to address contracting issues, representing Network Contracting in assigned project teams, communicate status of negotiations and document key financial and legal terms).
7. Recruit, train, supervise and/or manage direct reports to assure successful achievement of business and professional goals. as the business needs define. Support the execution of direct reports in performing all essential job functions of the Associate Contract Manager / Contract Manager role as described above.
The position requires a Bachelor's Degree. Master's degree preferred
Requires a minimum of 7-10 years of progressive experience in a managed health care environment with a thorough
knowledge of the health care market and the needs/concerns of health care providers. Direct contract negotiation or
relevant experience is also required. Understanding of Medicare, Medicare Advantage and the Medicaid markets is highly
desirable. Prior experience with mentoring, training and/or supervising staff is preferred.
Demonstrated ability to communicate effectively with physician leaders and high-level hospital, medical group or health
center administrators. Contract negotiation experience, including negotiating value based financial models, is required.
Work requires sound knowledge of health care reimbursement methodologies, as well as advanced financial analytic ability. Experience with Microsoft office analytic tools (e.g., Excel / MS Access) and developing executive level Powerpoint presentations is required.
Must be highly motivated individual with excellent organizational skills to manage large volumes of information and
multiple assignments; attention to detail is key.
Requires the ability to understand, interpret and educate others on all aspects of a contract: financial, legal, and operational
with emphasis on implementation of contract terms. Working knowledge of federal and state regulations as they apply to
senior products (e.g., Medicare Advantage and over 65 dual-eligible populations).
Possess strong customer focus and expertise in setting and managing customer expectations.
Requires initiative, sound judgment, and the ability to work independently under pressure in a constantly changing
environment balancing multiple priorities. Require the ability to learn and apply Tufts Health Plan's policies consistently
and seek out guidance when necessary.
Must be able to conceptualize and envision the impact of change, and propose new ways to do business. Must be flexible
and a proponent/champion of change.