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