Network Contract Manager

Presbyterian is seeking a Network Contract Manager 

The Provider Network Specialist is responsible for identifying network expansion opportunities and facilitating key recruitment related activities. The Provider Network Specialist drafts, reviews, negotiates and finalizes standard provider agreements, which includes but is not limited to single financial agreements based on sound analytical principles and approaches. The Provider Network Specialist provides implementation and ongoing support to Value Based Reimbursement and Value Based Program providers. The NCM I work assignments involve a low to moderately complex of variable factors. Work with minimal guidance; seek guidance on complex tasks.

 

• This is a Full Time position - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days

Ideal Candidate: Progressive network management experience including provider contracting and network administration in a healthcare organization.  Experienced in negotiating managed care contracts with physician groups, ancillary providers and hospital systems

• High School Diploma required.
• 1 to 3 years of progressive network management experience including provider contracting and network administration in a healthcare organization.
• Experienced in negotiating managed care contracts with physician groups, ancillary providers and hospital systems.
• Basic Knowledge of Medicare reimbursement methodologies.
• Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
• Excellent written and verbal communication skills
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency in MS Office applications
• Must be passionate about continuously improving provider experiences

• Use various department input and feedback, network adequacy reports, including competitive network analysis, etc., to identify network gaps in existing assigned networks and recruit providers so networks remain competitive and compliant with state and federal regulations.
• Collaborate with team and create strategies for meeting network growth.
• This position prepares simple reviews and analysis of projects financial impact of single financial agreements within predetermined parameters and alternate contract terms for discussion with contracting leadership team prior to and/or during external negotiation.
• Specific responsibilities include but are not limited to strategic positioning for single financial agreements with providers, network development, monitoring financial performances, and ensuring compliance with contracting guidelines.
• Responsible for managing assigned Project Plans on time and on schedule, which includes but is not limited to the use of project management tools and techniques to develop work plans, tasks, timelines, and measurements for all project assignments. Provides accurate and timely reports on project progress, identifying risks and opportunities and escalating as appropriate. Directs project through full lifecycle, including project initiation and requirements definition, planning, execution, monitoring, and project closure.
• This position involves a high degree of personal interaction with the management team, as well as providers and other health plan staff.
• This position will work directly with the department Director and Contract Manager on special projects.
• Position requires ability to facilitate and present simple ideas at inter-department meetings to ensure proper interpretation and configuration of contracts.
• Demonstrates a knowledge and understanding of providers to present and make recommendations regarding network needs, looking always to expand the network to support profitable market growth.
• Travel as required to meet with providers for purposes of recruitment and contracting related meetings.

About Presbyterian Healthcare Services
Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities - like challenges, webinars, and screenings - with opportunities to earn gift to earn gift cards and other incentives.

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships. Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

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

USD $35.29/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.