Supervisor Network Development-Provider Contracting

Now hiring Supervisor Network Development-Provider Contracting

 

Supervises team responsible for conducting provider contracting functions including reimbursement negotiations, as necessary, to achieve cost targets and support network strategies. Supervises and provides direction to team to support development of contracts for; acute inpatient facilities and integrated delivery systems; medical professionals and ancillary services; and special-purpose networks such as Medicaid long-term-care/behavioral/dental. Ensures that productivity and quality standards are maintained. Provides leadership and assistance to Network Contract Managers through supervision and coordination of daily operations. Major duties include, supervising day-to-day contracting operations, including; coordination of team resource assignments, mentoring of team members, and acting as point of contact/liaison for all team deliverables and accountabilities.

 

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

 

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

 

• Why Join Us:
• Full Time - Exempt: Yes
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
• Albuqueque metro applicants only please.  This is a Hybrid role. May be asked to come into the Albuquerque up to 3 times a week 

Ideal Candidate:

5 years experience in managed care or health care contracting preferred. Or 6 years relevant managed care/health care experience.

Requires effective coaching, counseling, and conflict management skills.

• Bachelors degree; at least 5 years experience in managed care or health care contracting preferred. Or 6 years relevant managed care/health care experience Requires effective coaching, counseling, and conflict management skills.
• Must be able to work collaboratively with other employees and the ability to multi-task.
• Demonstrated ability to sustain quality standards. Demonstrated ability to communicate in verbal and written form with peers, subordinates and the public, including physicians, physician office staff and staff.
• Ability to handle fluctuating workloads, conflicting priorities, and concurrent activities.
• Ability to influence many parties internally and externally, both inside and outside of formal reporting relationships
• Ability to synthesize, process, and authoritatively/persuasively communicate complex contractual and financial concepts. Ability to reconcile and balance multiple conflicting objectives, e.g. expanding network of contracted providers and increasing levels of provider satisfaction while meeting reimbursement cost management targets.
• Work team and matrixed project team leadership skills, including the ability to organize and manage multiple priorities under aggressive deadlines.
  
  Comprehensive knowledge of:
  *Payor-provider contracting in health benefits or managed care delivery systems
  *Managed care finance and operations
  *Complex reimbursement methodologies

• Supervises and provides day-to-day support to Network Contract Managers as is necessary to accomplish: a) Marketing an attractive managed care product throughout the State of New Mexico. b) Ensuring access to quality health care for health plan beneficiaries. c) Meeting enterprise goals of improving affordability and fiscal sustainability. d) Meeting health plan standards regarding operational administration and reimbursement automation.
• Serves as a first line of escalation in resolving complex provider contracts and reimbursement issues. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated and sensitive issues. Identifies necessity for additional escalation and communicates issues effectively to senior leadership.
• Oversees quality of team deliverables and assists with deliverables where required. i.e. Network Development agenda and data collection, Network Contract Manager work queues, contract and reimbursement issue resolution.
• Formulates work plans and assignments based on the analysis of the inventory workload, available personnel, and priorities.
• Ensures team members perform tasks in accordance with established department and organization policies and standards.
• Ensures team is focused on appropriate goals and removes barriers to success.
• Acts as a point of contact, liaison and escalation for all team solution delivery matters.
• Ensures that performance standards are being maintained by performing ongoing monitoring and audits of processes and workflows.
• Provides counsel and feedback to team members regarding audit and performance results
  
  

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness 
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift card and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian? 
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services 
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity 
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

 

#PHP123

USD $44.49/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.