Provider Contracting Manager jobs in Minnesota

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)

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Direct Contracting Manager - Midwest
  • TriWest Healthcare Alliance
  • Minneapolis, MN FULL_TIME
  • Profile


    Veterans, Reservists, Guardsmen and military family members are encouraged to apply!!

    Remote position based out of Minnesota, Illinois, North Dakota, Iowa


    Job Summary

    Develops and maintains provider relationships within designated state/territory that TriWest is responsible for direct contracting. Manages network development activity with network providers and recruits new providers to meet business needs. Develops hospital, physician and ancillary service agreements, ensures adherence with government operational manuals, monitors network shortfalls, and resolves access issues throughout the assigned region. Facilitates resolution of escalated provider issues, and promotes TriWest Corporate initiatives.


    Education & Experience

    Required:

    • Bachelor's degree in Business, Health Care Administration or equivalent experience
    • Experience managing large or complex provider contracts
    • 5 years of experience in a Managed Care or equivalent health care environment
    Preferred:

    • Experience in provider contracting for government programs and/or commercial lines of business
    • Has established relationships and resides in the market for which the position is located.
    • Management experience in the healthcare industry
    • Experience in utilizing a contract management system to manage contracting workflow
    • Negotiation experience
    • Managing Provider Data
    • Understanding Claims issues and terms


    Key Responsibilities


    • Provides legendary service and support to maintain strong relationships with internal and external customers.
    • Develops negotiation strategies for areas of responsibility to achieve individual and department performance metrics.
    • Develops strategic plan to meet network adequacy needs for areas of responsibility and submits to Sr. Manager for inclusion in overall network development plans.
    • Regularly reviews and determines appropriate network access and development and makes recommendations to support network build activities.
    • Provides regular updates to the Director and/or VP regarding provider network development, management, and access for assigned areas.
    • Monitors and ensures resolution of routine and escalated provider issues.
    • Communicates information regarding market needs, competition, and industry trends to management team.
    • Provides training and development to team members.
    • Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
    • Maintains client confidence and ensures confidential information is protected.

    • Works with Provider Services leadership to accurately assess network provider needs within assigned region and establish strategies to achieve them.
    • Proactively manages provider networks in assigned areas and functions as primary internal spokesperson on network issues.
    • Periodically visits network providers to inform partners about progress towards agreed-upon goals and upcoming network enhancements; coordinates account planning and maintenance issues.
    • Provides development and training to Network Providers on changes and updates to TriWest processes and policies.
    • Identifies issues for future educational seminars that are identified through provider interactions.
    • Collaborates with Provider Education to incorporate these ideas in upcoming provider education materials and updates.
    • Assists provider community with any claims issues, including Electronic Media Claim filing problems, reimbursement issues, and billing questions. Answer general questions on credentialing process and technical aspects of the Program.
    • Monitors and responds to network shortfalls within region.
    .:

    • Demonstrate and maintain current knowledge of all programs, contracting, credentialing, reimbursement and operational policies and TriWest initiatives, operations, and goals.
    • Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
    • Collaborate closely with other department leadership, staff, and executive leadership on process improvement to promote service level improvements or facilitate new processes.
    • Head or participate in projects and committees assigned by Sr. Contracting Manager or Vice President.
    • Performs other duties as assigned.
    • Regular and reliable attendance is required.


    Competencies


    Communication / People Skills:
    Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

    Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

    Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.

    Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

    High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

    Leadership: Successfully manage provider relationships and lead contract negotiations; takes accountability and follows through on service related requests. Responds with an appropriate sense of urgency.

    Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

    Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.

    Technical Skills: Working knowledge or familiarity with Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare, TRICARE, VAPC3), and the insurance industry; skill in diplomacy and negotiation; skill in financial analysis to analyze contractual reimbursement; skill in project management; skill in presentation; proficient with Excel.

    Working Conditions


    Working Conditions:


    • Availability to work non-regular hours as necessary
    • Works within a standard office environment, with travel as needed
    • Must be able to obtain appropriate DITSCAP security clearance

    Company Overview


    Taking Care of Our Nation’s Heroes.

    It’s Who We Are. It’s What We Do.

    Do you have a passion for serving those who served?

    Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!

    Our job is to make sure that America’s heroes get connected to health care in the community.

    At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.


    Benefits


    We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

    • Medical, Dental and Vision Coverage
    • Generous paid time off
    • 401(k) Retirement Savings Plan (with matching)
    • Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
    • Tuition reimbursement
    • Paid volunteer time


    *Annual base salary for Colorado and Washington State residents: $79,000 - $87,000 depending on experience*


    Equal Employment Opportunity


    TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

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General Manager - Gas Distribution
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Sales Manager
  • Mission Contracting, LLC
  • Lakeville, MN FULL_TIME,CONTRACTOR
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Project Manager/Estimator
  • New Look Contracting, Inc.
  • Rogers, MN FULL_TIME
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Roofing Sales Manager
  • Bold North Roofing and Contracting
  • , MN FULL_TIME
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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Phoenix, AZ
  • Position: Provider Contract Manager REMOTE Seattle Area Location: Remote - Everett, Seattle, Tacoma, Washington State Me...
  • 4/25/2024 12:00:00 AM

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Los Angeles, CA
  • Position: Provider Contract Manager REMOTE Seattle Area Location: Remote - Everett, Seattle, Tacoma, Washington State Me...
  • 4/25/2024 12:00:00 AM

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Irvine, CA
  • Position: Provider Contract Manager REMOTE Seattle Area Location: Remote - Everett, Seattle, Tacoma, Washington State Me...
  • 4/25/2024 12:00:00 AM

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Nashville, TN
  • Position: Provider Contract Manager REMOTE Seattle Area Location: Remote - Everett, Seattle, Tacoma, Washington State Me...
  • 4/25/2024 12:00:00 AM

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Provider Contract Manager *REMOTE Seattle Area*
  • Dexian
  • Chicago, IL
  • Position: Provider Contract Manager REMOTE Seattle Area Location: Remote - Everett, Seattle, Tacoma, Washington State Me...
  • 4/25/2024 12:00:00 AM

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Provider Contracting Manager
  • Health New England
  • SUMMARY: The Provider Contracting Manager is responsible for leading or assisting with network development activities of...
  • 4/23/2024 12:00:00 AM

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Provider Contract Management Specialist
  • Cambia Health Solutions Inc
  • Portland, OR
  • Provider Contract Management Specialist Remote opportunity for residents of OR, WA, ID and UT Primary Job Purpose The Pr...
  • 4/23/2024 12:00:00 AM

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Provider Contract Management Specialist
  • Cambia Health Solutions, Inc
  • Portland, OR
  • Provider Contract Management Specialist Remote opportunity for residents of OR, WA, ID and UT Primary Job Purpose The Pr...
  • 4/22/2024 12:00:00 AM

Minnesota (/ˌmɪnɪˈsoʊtə/ (listen)) is a state in the Upper Midwest and northern regions of the United States. Minnesota was admitted as the 32nd U.S. state on May 11, 1858, created from the eastern half of the Minnesota Territory. The state has a large number of lakes, and is known by the slogan the "Land of 10,000 Lakes". Its official motto is L'Étoile du Nord (French: Star of the North). Minnesota is the 12th largest in area and the 22nd most populous of the U.S. states; nearly 60% of its residents live in the Minneapolis–Saint Paul metropolitan area (known as the "Twin Cities"). This area i...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Contracting Manager jobs
$111,687 to $148,321

Provider Contracting Manager in Gastonia, NC
By simplifying and automating the provider contracting lifecycle, we help make it easier for health plans to identify and implement savings opportunities to obtain maximum value from provider relationships.
January 09, 2020
Provider Contracting Manager in Springfield, IL
Responsible for the oversight of their assigned networks to ensure network provider deficiencies are being met and working closely with their assigned Network Support staff and Medical Management counterparts to ensure network needs/changes are being effectively addressed and communicated both internally and externally.
January 19, 2020
Provider Contracting Manager in Cedar Rapids, IA
New care delivery models, complex regulations and narrowing provider networks have significantly altered the provider contract management process.
February 03, 2020