Provider Contract Manager

Avera Health Plans

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Pay Range:

The pay range for this position is listed below. Actual pay rate dependent upon experience.

$77480.00 $117000.00

Position Highlights

This position is an On Site position located in Sioux Falls SD.

If the candidate lives in Iowa or Nebraska there may be opportunities for Hybrid work.

May be eligible for a relocation bonus.

The optimal candidate has experience with Provider Contracting.

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

The Provider Contract Manager is a critical member of Avera Health Plans (AHP) Network Management team. The position supports AHPs network recruitment and development initiatives and functions as a liaison between providers the organization and its customers. Responsibilities include driving AHPs provider network expansion efforts performing detailed market analysis and intelligence gathering as well as maintaining network KPI reports and performance dashboards. In addition this role will assist provider training orientation and coaching for performance improvement within the network.

What you will do

• Responsible for the development and implementation of negotiating strategies financial analyses and performance improvement strategies to ensure Avera Health Plans meets its financial performance targets.
• Develop geographically competitive stable networks that achieve Avera Health Plans objectives for performance network adequacy and accessibility of provider specialty types; and develop and implement a network development plan for the Avera footprint providers and identify and initiate contact with potential providers in support of Avera Health Plans strategic goals and objectives. Recruit and develop provider networks to meet ongoing business and client benefit needs and negotiate contracts with hospitals clinics and physician groups service agreements.
• Understand industry landscape and ensure adherence to best practice and regulatory mandates relative to provider networks claims outcomes and medical expense integrating them into Network Services and reimbursement configuration processes.
• In partnership with your leader Provider Relations and Contracting lead the development negotiation and implementation of broad based tiered and narrow network products and valuebased contract arrangements. Also lead medical cost reduction programs to identify network cost savings and unit cost improvement opportunities develop action plans and successfully implement them; and support all aspects of the valuebased care negotiation process including contracting and negotiation strategy financial modeling and pricing with the ability to validate date directly tied to population health and valuebased care.
• Provide insightful competitive intelligence to inform leadership of industry trends market composition and best practices related to provider network expansion.
• Foster and maintain strong relationships with healthcare provider representatives building effective collaborations and facilitating successful agreements; and utilize technology tools and dashboards to track trends generate reports and analyze expansion metrics to inform progress and support network management strategies.
• Work cross functionally design and implement recruitment strategy and supporting collateral to support Avera Health Plans network expansion and practitioner development initiatives. Ensure providers have proper documentation to join and remain in the network.
• Maintain provider manual and policies and maintain contract database and associated files.
• In collaboration with others on the team conduct periodic audits to ensure network adequacy requirements are met and ensure compliance with applicable regulations and polices and participate in the development of business strategy to achieve contract objectives. Evaluate opportunities to integrate new ideas concepts technologies data processes and business models into existing organizational capabilities including recommending strategic/tactical options including consideration of similar capabilities across the organization implementation challenges and business priorities.
• Execute on special projects as assigned.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others hear understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge skills and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions as long as the accommodations do not cause undue hardship to the employer.

Required Education License/Certification or Work Experience:

• Bachelors
• 13 years Applicable experience within Provider Relations and Contracting

Preferred Education License/Certification or Work Experience:

• Masters
• Provider Network Management Provider Network Development Talent Acquisition and/or Sales and Marketing

Expectations and Standards

• Commitment to the daily application of Averas mission vision core values and social principles to serve patients their families and our community.
• Promote Averas values of compassion hospitality and stewardship.
• Uphold Averas standards of Communication Attitude Responsiveness and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles laws regulations and standards associated with but not limited to CMS The Joint Commission DHHS and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying parttime and fulltime employees. We support you with opportunities to help live balanced healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.

• Free health insurance options for fulltime single coverage on Avera High Deductible Health Plan

• Up to 5 employer matching contribution for retirement

• Career development guided by handson training and mentorship

Avera is an Equal Opportunity Employer Qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability Veteran Status or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application please callor send an email to .