Provider Contracting Manager

HMSA Provider Strategy You are responsible for being an active participant in shaping, informing, leading, and implementing HMSA’s overall corporate strategy to its providers. You are expected to play an integral role in supporting, including implementing, various strategic provider initiatives and working closely with other HMSA Departments—including Office of Payment Transformation, Finance and Accounting, Medical Management, Medicare and Medicaid Programs, IHMS, and Market and Product Strategy—to coordinate and implement strategic provider initiatives. These responsibilities include, but are not limited to, the following: Financial Strategy – Aligned with HMSA mission, vision, values and provider strategy, develop, shape and evaluate financial proposals being negotiated with providers, including value‑based payment, HMSA’s Advanced Hospital Care program, or other alternative payment models. Work closely with HMSA leadership, Finance and Accounting, Quality Management, Provider Operations, Medical Management, Office of Payment Transformation and Corporate Analytics departments to develop and/or evaluate financial proposals. Negotiate financial proposals directly with providers. Negotiate Contracts – Negotiate standard and non‑standard agreements with providers by working closely with Legal, Business Integrity, Provider Operations, Finance and Accounting, Credentialing, Office of Payment Transformation, and other HMSA departments to ensure that the arrangement reached with each provider drives HMSA provider strategy while mitigating corporate legal, regulatory and operational risks. This includes reviewing and evaluating red‑lined contracts, making language recommendations, negotiating directly with providers and their agents, and being responsible for the overall negotiated arrangement with the provider. Monitor and manage the disbursement of funds for HMSA contract obligations for non‑claims expenses. This includes programs/projects such as strategic community investment funds, recruiting programs, and bonuses for quality or volume. Evaluate and communicate with Senior Executives and interested departments on program effectiveness. Relationship Management: Provider Partnering – Develop close partnerships with providers to (1) lead and drive HMSA’s mission, vision, values and provider strategy and (2) facilitate strategic contracting with providers. Monitor and evaluate the status of HMSA relationships with providers to better inform HMSA provider and contracting strategy. Responsible for identifying and coordinating, among internal and external stakeholders, the resolution of provider issues. HMSA Internal Partnering – Develop close partnerships with various HMSA Departments to continuously develop and improve upon HMSA’s provider strategy. At a detailed level, coordinate provider contractual requirements to ensure appropriate implementation and administration of provider contracts and negotiated arrangements. This includes, but is not limited to, (1) working with Finance and Accounting to ensure adherence to broader HMSA financial requirements including revenue recognition, pricing, and discounting policies, (2) understanding and evaluating the financial impact of provider proposals and working closely with Finance and Accounting to implement contractual requirements, and (3) working with departments focused on operational, regulatory, and clinical outcomes to ensure provider contracts meet requirements and render appropriate, quality, and affordable care to members. Internal Operations: Maintain contractual records and documentation such as receipt and control of all contract correspondence, customer contact information, contractual changes, status reports, and other documents for all projects. Ensure that signed contracts are communicated to all relevant parties to provide contract visibility and awareness, interpretation to support implementation, and that all parties comply with contract terms. Ensure contract close‑out, extension, or renewal. Develop and implement procedures for contract management and administration in compliance with company policy and to mitigate risk to the company. Contribute to or influence company policies as appropriate, and develop and prepare regular reports on the status of contracts and negotiations based on detailed analysis. Other duties as assigned: As needed, work directly on corporate initiatives—including strategic provider initiatives—provide guidance on contract matters to supervisors or other operational staff, including training new project stakeholders and other employees in contracting practices and procedures. Perform all other miscellaneous responsibilities and duties as assigned or directed.

• LI-Hybrid
• J-18808-Ljbffr HMSA