Network Contract Manager

Network Contract Manager

Requisition ID

2024-43602

Category

Quality/Safety

Location : Name

Rev Hugh Cooper Admin Center

Location : City

Albuquerque

Location : State/Province

NM

Minimum Offer

USD $22.44/Hr.

Maximum Offer for this position is up to

USD $34.27/Hr.

Overview

Now hiring a


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.

How you belong matters here.
We value our employees' differences and find strength in the diversity of our team and community.
At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us
Full Time - Exempt: Yes

Job is based Rev Hugh Cooper Admin Center
Work hours: Days
Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
Qualifications

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
Responsibilities

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.

Benefits

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

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


Compensation Disclaimer

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.

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