Senior Contract Manager, Medicare
Company: Point32Health
Location: North Billerica
Posted on: June 25, 2022
Job Description:
The position of Senior Contract Manager for Senior Products
serves as the primary point of contact with provider organizations
to negotiate and manage contracts with network physicians and
hospitals. This individual is the primary lead during negotiations
and is accountable for the financial and legal terms negotiated
with the provider organizations. This individual will assure that
contract terms are consistent with the corporate and Senior
Products contracting strategies, and are negotiated within the
established legal and financial guidelines as established by Tufts
Health Plan. This individual will assure that any non-standard
elements of any contract negotiation have been properly researched
and communicated to key internal stakeholders. This individual also
will coordinate with the appropriate personnel from the Provider
Engagement and Implementation team to oversee the successful
implementation of contract terms within the organizations system
and processes. In addition, the Senior Contract Manager is
responsible for training and supervising one or more internal team
members as needed, and for leading projects within the department.
The individual will mentor, guide and support staff within the
department to help assure the successful achievement of business
and professional goals. This may include, but is not limited to,
reviewing contracts and/or developing contract templates, providing
guidance on contracting strategies, and facilitating a resolution
to complex financial, legal, compliance, reporting or
implementation challenges. Should there be a business need for this
individual to manage direct reports, they will be expected to
provide coaching, feedback and direction to staff to assure the
successful achievement of business and professional goals. This
includes developing recruitment and retention plans for such
individual(s).The Senior Contract Manager will also provide support
to the Director in developing contracting strategies to accommodate
the ever changing Medicare Advantage market, including exploring
new product offerings, potential network expansion/development and
alternative contracting models. This individual will represent
Network Contracting in both internal and external meetings specific
to contracting related interests as they apply to Clinical
Services, Risk Adjustment, Actuarial services, Claims and Sales
within the Senior Division or enterprise wide functions if
applicable.KEY RESPONSIBILITIES:Essential functions occur
simultaneously. The employee must be able to appropriately handle
each essential function, prioritize with minimal direction, and
seek assistance when necessary. These functions need to be
performed on a consistent and regular basis, using good
judgment.ESSENTIAL FUNCTIONS
- Negotiate contractual arrangements with established or
potential network providers for the Senior product lines, within
budgeted targets and regulatory requirements. Direct analyses to
support contract negotiations, oversee the development of contract
documents, and summarize contractual terms, legal and financial,
for implementation by the Provider Engagement and Implementation
area.
- Lead Senior Leadership meetings between THP and our provider
network. Effectively articulate to THP's position on key issues
relevant to the contract negotiation. Manage and position the
negotiation so that THP meets the key objectives that have been
identified for the contracting cycle.
- Work closely with the legal and compliance departments to
assure contract provisions are consistent across providers and
assure all applicable legal terms are included in the signed
contract.
- Summarize and document any non-standard elements of the
negotiations. Communicate results to applicable internal
departments.
- Understand, with a high degree of specificity, important
business aspects such as Medicare and Medicaid rules and
regulations, reimbursement methodologies, claims trend,
provider/TMP financial performance, and any analytical tools
utilized by THP to understand the performance, financial and
otherwise, of the provider network.
- Lead and/or participate in cross functional projects and
meetings to support key business initiatives (such as managing
Senior Division projects related to specific contracting
strategies, facilitating internal ad hoc groups to address
contracting issues, representing Network Contracting in assigned
project teams, communicate status of negotiations and document key
financial and legal terms).
- Recruit, train, supervise and/or manage direct reports to
assure successful achievement of business and professional goals.
as the business needs define. Support the execution of direct
reports in performing all essential job functions of the Associate
Contract Manager / Contract Manager role as described
above.KNOWLEDGE, SKILLS AND ABILITIES:EDUCATIONThe position
requires a Bachelors Degree. Masters degree
preferredEXPERIENCERequires a minimum of 7-10 years of progressive
experience in a managed health care environment with a thorough
knowledge of the health care market and the needs/concerns of
health care providers. Direct contract negotiation or relevant
experience is also required. Understanding of Medicare, Medicare
Advantage and the Medicaid markets is highly desirable. Prior
experience with mentoring, training and/or supervising staff is
preferred.Demonstrated ability to communicate effectively with
physician leaders and high-level hospital, medical group or health
center administrators. Contract negotiation experience, including
negotiating value based financial models, is required.Work requires
sound knowledge of health care reimbursement methodologies, as well
as advanced financial analytic ability. Experience with Microsoft
office analytic tools (e.g., Excel / MS Access) and developing
executive level Powerpoint presentations is required.COMPLEXITYMust
be highly motivated individual with excellent organizational skills
to manage large volumes of information and multiple assignments;
attention to detail is key.Requires the ability to understand,
interpret and educate others on all aspects of a contract:
financial, legal, and operational with emphasis on implementation
of contract terms. Working knowledge of federal and state
regulations as they apply to senior products (e.g., Medicare
Advantage and over 65 dual-eligible populations).Possess strong
customer focus and expertise in setting and managing customer
expectations.Requires initiative, sound judgment, and the ability
to work independently under pressure in a constantly changing
environment balancing multiple priorities. Require the ability to
learn and apply Tufts Health Plans policies consistently and seek
out guidance when necessary.Must be able to conceptualize and
envision the impact of change, and propose new ways to do business.
Must be flexible and a proponent/champion of change.PERSONAL
CONTACTSExcellent interpersonal skills are necessary to develop
strong working relationships with internal and external contacts.
Requires excellent diplomacy, oral and written communication skills
as well s the ability to coordinate efforts amongst various
departments at THP. Must be able to work cooperatively as a team
member. Must possess the skills to train/educate and manage
department staff.CONFIDENTIAL DATAAll information (written, verbal,
electronic, etc.) that an employee encounters while working at
Tufts Health Plan is considered confidential. Strict
confidentiality is required for all clinical information that one
encounters and works with as part of the job. Requires as high
degree of confidentiality with regards to the financial and
political issues associated with contractual agreements. Requires
confidentiality regarding the Health Plans initiatives, strategies
and product related contractual development.MENTAL/PHYSICAL
REQUIREMENTSFast-paced office environment handling multiple
demands. Moderate use of telephone and extensive use of PC
required.Requires that the individual be organized while being
readily adaptable to changes in work priorities.PHYSICAL WORK
ENVIROMENTBusiness environment.ADDITIONAL REQUIREMENTS (TRAVEL,
WEEKEND HOURS)Must be flexible to travel and work additional hours
(early morning, evening and weekend). Valid drivers license and the
ability to provide transportation are required.RequirementsRequires
a minimum of 7-10 years of progressive experience in a managed
health care environment with a thorough knowledge of the health
care market and the needs/concerns of health care providers. Direct
contract negotiation or relevant experience is also required.
Understanding of Medicare, Medicare Advantage and the Medicaid
markets is highly desirable. Prior experience with mentoring,
training and/or supervising staff is preferred.Demonstrated ability
to communicate effectively with physician leaders and high-level
hospital, medical group or health center administrators. Contract
negotiation experience, including negotiating value based financial
models, is required.Work requires sound knowledge of health care
reimbursement methodologies, as well as advanced financial analytic
ability. Experience with Microsoft office analytic tools (e.g.,
Excel / MS Access) and developing executive level Powerpoint
presentations is required.What we build together changes our
customer's health for the better. We are looking for talented and
innovative people to join our team. Come join us!Please note: As of
January 18, 2022, all employees including remote employees must be
fully vaccinated. This position will require the successful
candidate to show proof of full vaccination against COVID-19.
Point32Health is an equal opportunity employer, and will consider
reasonable accommodation to those individuals who are unable to be
vaccinated consistent with federal, state, and local law. About
UsPoint32Health is a leading health and wellbeing organization,
delivering an ever-better health care experience to everyone in our
communities. Building on the quality, nonprofit heritage of our
founding organizations, Tufts Health Plan and Harvard Pilgrim
Health Care, we leverage our experience and expertise to help
people find their version of healthier living through a broad range
of health plans and tools that make navigating health and wellbeing
easier.At Point32Health, were working to reshape the world of
health care by pushing past the status quo and delivering even more
to the diverse communities we serve: more innovation, more access,
more support, and healthier lives. And we want people like you on
our side to make it even better.This job has been posted by
TalentBoost on behalf of Point32Health. TalentBoost is committed to
the fundamental principle of equal opportunity and equal treatment
for every prospective and current employee. It is the policy of
TalentBoost not to discriminate based on race, color, national or
ethnic origin, ancestry, age, religion, creed, disability, sex and
gender, sexual orientation, gender identity and/or expression,
military or veteran status, or any other characteristic protected
under applicable federal, state or local law.Req ID:
R3525#TalentBoostPoint32Health
Keywords: Point32Health, Boston , Senior Contract Manager, Medicare, Executive , North Billerica, Massachusetts
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