Centene Corporation Manager, Contracting in Waltham, Massachusetts

Description:

Position Purpose: Lead, negotiate, and manage multiple hospital, large medical group, physician, school and/or ancillary contracting activities in accordance with Corporate, health plan, and state guidelines.

  • Oversee all activities of the contracting department
  • Develop and implement a network development plan for an assigned region and set of providers and identify and initiate contact with potential providers
  • Negotiate contracts with interested providers utilizing model provider agreements, and follow up on contracts
  • Lead negotiations, rate modeling, implementation and ongoing monitoring of assigned group of providers to maximize business relationships and opportunities
  • Oversee provider set-up and contract configuration to ensure accurate claims adjudication and facilitate the organization of provider focus groups
  • Evaluate and monitor providers performance standards and financial performance of contracts
  • Ensures compliance with national contracting standards, reimbursement standards, provider set-up rules, exception process and use of model contract language
  • Perform financial analyses to identify medical cost improvement opportunities and develop and execute contracting action plans to achieve results

Qualifications:

Education/Experience: Bachelor s degree in Healthcare Administration, Business Administration, Marketing, related field or equivalent experience. 4 years of provider relations/contracting experience in a healthcare and/or managed care environment. Working knowledge of contracting language and the principles of negotiation. Familiarity with managed care, State and/or Federal health care programs. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

License/Certification: Valid driver's license.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Job: Network Development & Contracting

Organization: CeltiCare

Location: Massachusetts-Waltham

Requisition ID: 1045622