Provider Contracting Manager manages the activities of the contracting staff that prepare and maintain contracts and the contracts database system for a health plan network. Responsible for negotiating with facilities joining the health network and setting rates. Being a Provider Contracting Manager oversees network reporting requirements to ensure compliance with regulatory agencies, and to produce accurate and relevant reporting of data. Trains and develops staff. Additionally, Provider Contracting Manager requires a bachelor's degree. Typically reports to a head of a unit/department. The Provider Contracting Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Provider Contracting Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
Resp & Qualifications
PURPOSE:
We are looking for an experienced people leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and at last two days a week at a CareFirst location based on business needs and work activities/deliverables that week.
This role is responsible for managing the ongoing adequacy and competitiveness of the CareFirst provider networks. The emphasis is on competitive market positioning and assuring our networks allow for the appropriate access to healthcare services in accordance with the CareFirst mission. This includes but is not limited to: formulation of contracting and reimbursement policy and strategy, negotiating legacy fee-for-service reimbursement terms, compliance with all network adequacy standards and contractual regulatory requirements, expanding the breadth and depth of CareFirst Value Based Agreements and implementation of new innovative networks and/or network innovation to support growth and expansion to new markets.
ESSENTIAL FUNCTIONS:
SUPERVISORY RESPONSIBILITY:
This position manages people.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Business, Healthcare Administration, Finance, or related discipline OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience:
Preferred Qualifications:
Knowledge, Skills and Abilities (KSAs)
Salary Range: $136,000 - $252,450
Travel Requirements
Estimate Amount: 10%-day travel to provider offices within the CF service area on an as needed basis.
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
Professional Contracting
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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