Health Plan Provider Contracts Manager - Complex

Role Overview This position provides expertise and leadership in complex health plan provider network contracting, focusing on network development, financial, and operational performance. Responsibilities include negotiating agreements with strategic provider groups such as hospitals, physician groups, and behavioral health organizations, emphasizing value-based payment models. The role involves managing contract execution, analyzing financial impacts, and supporting network adequacy and compliance with regulatory standards. It also includes developing provider relationships, recruiting providers, and engaging in renegotiations to control costs and improve network quality. The position requires clear communication of contract terms and reimbursement structures to providers, participation in fee schedule and reimbursement model development, and collaboration with internal teams and leadership on strategic initiatives. Additionally, it involves mentoring team members and supporting special projects, with travel throughout the state. Qualifications & Skills Minimum 5 years of experience in network contracting with large provider groups, including negotiations in managed healthcare settings, with familiarity in various payment methodologies such as value-based payment, FFS, and capitation. Strong negotiation, relationship-building, and regulatory navigation skills. Data-driven decision-making, analytical capabilities, organizational skills, and attention to detail. Effective communication skills and proficiency in Microsoft Office and contract management software. Ability to work cross-functionally and manage multiple tasks simultaneously. Preferred Skills Experience with integrated delivery systems, hospitals, and specialty groups. Knowledge of Medicaid, Medicare, and government-sponsored programs.

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