Manager, Provider Contracting

Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

A Manager, Provider Contracting is responsible for leading a team to negotiate, manage, and maintain contracts with providers to ensure financial and regulatory compliance. Key duties include developing contract strategies, overseeing contract lifecycle management, ensuring legal and regulatory compliance, and mentoring the team to achieve key performance indicators (KPIs) related to turnaround times and compliance. The role requires strong leadership to manage contract negotiations, build provider relationships, and monitor financial performance.

Key Accountabilities

• Team leadership: Mentor and manage a team of contract managers, guiding them through complex negotiations and ensuring they meet performance goals and deadlines.
• Strategic negotiation: Lead and support contract negotiations with providers to secure favorable terms that support the organization's financial and strategic objectives.
• Contract lifecycle management: Oversee the entire contract lifecycle from initiation, creation, and negotiation to execution, monitoring, and renewal/termination.
• Compliance and regulatory adherence: Ensure all contracts and processes comply with federal, state, and industry standards and legal requirements.
• Financial and operational oversight: Analyze contract performance, monitor key financial metrics like reimbursement rates, and make recommendations for improvement.
• Relationship management: Foster and maintain strategic relationships with provider partners
• Process improvement: Develop and maintain policies, procedures, and templates for contracting. Identify opportunities for internal process improvement and implement new provider programs or payment models.
• Cross-functional collaboration: Liaise with other departments, such as billing, legal, and operations, to ensure accurate implementation and understanding of contract terms.

Required Qualifications

• Bachelor's degree in healthcare, finance, economics, or equivalent experience in related field
• 5 years of related experience beyond degree as a people leader in contract negotiations and healthcare

Skills and Abilities

• Proven track record as a team leader with staff management skills
• Excellent communication (written, verbal and presentation) skills
• Proven track record of cultivating and maintaining effective, collaborative external relationships where the parties trust information that's conveyed
• A proven track record as a successful contract negotiator for health care services, provider or health plan
• Flexibility and creativity in developing effective contracting terms
• Knowledge of provider contracting components and strategies such as but not limited to risk-based contracting, financial models, operational impact and data analytics
• Demonstrated understanding of complex financial arrangements and quality programs across health care products
• Strong financial, analytical and problem solving skills, and understanding of legal documents
• Strategic-thinking skills with the ability to conceptualize a wide range of scenarios and the ability to analyze each scenario to come up with the most viable option
• An understanding and appreciation for standardizing processes to generate efficiencies and improve service levels

This position is a Remote role.To be eligible for consideration, candidates must have a primary home address located within any state where Medica is registered as an employer - AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI

The full salary grade for this position is $100,300 - $172,000. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $100,300 - $150,465. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.