Senior Consultant Provider Network Management

Job Summary

With minimal direction, acts as the key contact and subject matter expert for all contract-related activities. This includes developing and negotiating contract terms, conditions, modifications, penalties and incentives, while working with key stakeholders to ensure that their requirements are met. Analyzes and evaluates change to drive continuous improvement in the process of contract management and contract management trends. Leads the proactive, methodical management of contracts from initiation through execution, compliance and renewal. Provides support for management of medical cost of care and efficiency initiatives. Additionally, this position manages the contract execution process, resolving problems, mitigating delays, mediating disputes and escalating issues. Staff members in this position are effective and self-sufficient in working within a diverse selection of contracts and providers. Regularly provides guidance and training to less experienced Specialists.

Essential Functions

• Manages the contract development and negotiations process for provider networks initiatives.

• Enters and maintains current information in the internal contract repository and system contract database.

• Create and executive network development plans and deploy strategies to move providers to desired contract terms according to guidelines and standards. Provide effective oversight of contract implementation process ensuring all contracts are within required guidelines and financial parameters.

• Act as the principle contract negotiator for all assigned contracts. Manages contract review meetings to ensure delivery against objectives and contract budgets; develops regular reports on contract milestones and performance; and informs internal customers of activities and progress, through both verbal and written communications.

• Interface routinely with hospital and leadership on an independent basis while understanding other political sensitivities of assigned groups.

• Work with and involve relevant stakeholders as needed in negotiation decisions impacting legal or regulatory requirements, contract standards, cost target and payment and pricing methodologies. Facilitate contract implementation process with the PIM team, including payment rates, provider groupings, risk poll assignment, administration and other fees. Work collaboratively with PIM and other internal staff to find solutions to provider issues concerning payment and operation procedures, when necessary.

• Creates a customer focused, service based approach to working with stakeholders which emphasizes the creation and cultivation of cross-organizational relationships.

• May represent contracting at external and Joint Operating Committee meetings. May oversee development and implementation of network expansion and individual physician recruitment within an assigned geographic area. May be requested to present and represent Provider Network Contracting at meeting with external constituencies.

• Provides mentoring to less experienced team members and is accountable as a role model for customer service excellence.

Qualifications

Required

• Bachelor's Degree or equivalent in business administration, health care administration, psychology, finance, health and human services

• 5 years of relevant experience negotiating and managing contract lifecycles on behalf of either third party payers or health care providers

• 7 years of relevant experience leading negotiations directly and independently or leading a provider contracting team in negotiations

• Experience in finance or contract management and knowledge of CMS and commercial pricing practices and methodologies

• Experience working with legal staff

Preferred

• Master's Degree

• Skills in best practices for contract negotiation tactics and strategies

• Working knowledge of anti-trust laws

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

• Optional identity theft protection, home and auto insurance, pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1231 E Beltline - Grand Rapids

Department Name

PH - Provider Network Contracting

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:00 a.m. to 5:00 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.