The position of 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 health systems, network physicians, hospitals and health centers located in Massachusetts.
This individual is the primary lead during negotiations and is accountable for the financial and legal terms negotiated with providers, which includes value-based, fee for service rates, quality incentive and non-financial terms. 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 Performance Management and Contract Implementation teams to oversee the successful transition of contract terms within the organization's system and processes.
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.
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 successful implementation.
Work closely with the legal and compliance department to ensure contract provisions are consistent across providers and ensure all applicable legal/regulatory terms are included in the signed agreement. Understand organizational priorities as well as regulations to ensure legal and organizational compliance.
Articulate to network providers Tufts Health Plan's position on key issues relevant to the contract negotiation and contract requirements. Manage and position the negotiation so that Tufts Health Plan meets the key objectives that have been identified for the contracting cycle. Establish and maintain effective working relationships with your counterparts in the network.
Summarize and document any non-standard elements of the negotiations. Communicate results to applicable internal departments.
Understand, with a high degree of specificity, important business aspects such as Medicare and Medicaid rules and regulations, reimbursement methodology, claims trend, provider financial performance, and any analytical tools utilized the Tufts Health Plan to understand the performance, financial and otherwise, of the provider network.
Lead and/or participate in cross functional meetings as required; lead and/or collaborate on with key stakeholders to address contracting issues, communicate status of negotiations, coordinate with Performance Management teams on strategy development and educate teams on and key financial and legal terms.
The position requires a Bachelor's degree in health care, business administration or related field. Master's degree in health care or business administration preferred
Requires a minimum of 5-7 years 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 in the Massachusetts market is highly desirable. Understanding of Medicare and Medicare Advantage payment methodologies is strongly preferred.
Demonstrated ability to communicate effectively with physician leaders and high-level hospital administrators. Contract negotiation experience specifically in risk based financial models is highly desirable. Work requires sound knowledge of health care reimbursement methodologies with emphasis on value based arrangements, 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 and interpret all aspects of a contract: financial, legal/compliance and operational with emphasis on implementation of contract terms.
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.
Excellent interpersonal skills are necessary to develop strong working relationships with internal and external contacts.
Requires excellent diplomacy, oral and written communication skills as well s the ability to coordinate efforts amongst various departments at THP. Must be able to work cooperatively as a team member.
All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Strict confidentiality is required for all clinical information that one encounters and works with as part of the job. Requires as high degree of confidentiality with regards to the financial and political issues associated with contractual agreements. Requires confidentiality regarding the Health Plan's initiatives, strategies and product -related contractual development.
Fast-paced office environment handling multiple demands. Moderate use of telephone and extensive use of PC required.
Requires that the individual be organized while being readily adaptable to changes in work priorities.
PHYSICAL WORK ENVIROMENT
ADDITIONAL REQUIREMENTS (TRAVEL, WEEKEND HOURS)
Must be flexible to travel (primarily in Massachusetts) and work additional hours (early morning, evening and weekend). Valid driver's license and the ability to provide transportation are required.
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled