Health Partner Network Manager

Job Summary:The Health Partner Network Manager executes the Health Partner contracting strategy, develops contract provisions based on cost, quality/analysis and monitors key metrics for the assigned Market.Essential Functions:Create, execute and administer value based reimbursement (VBR) strategies as directedConduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting initiativesResponsible for provider recruitment, contracting and initiating the loading and credentialing processesResponsible for following up / auditing providers as they proceed through the loading process to ensure accuracyCreate contract language and review with legal to develop approved contract templates specific to the assigned Market and within the established corporate guardrailsAnalyze financial data and establish rates in collaboration with Provider Contracting leadership and FinanceNegotiate and re-negotiate hospital, ancillary, physician and behavioral health contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policiesBuild networks to support new products within the market and on-board new providersResponsible for complying with all regulatory requirementsPerform gap analysis to ensure no gaps and/or sanctions occur; identify potential providers to recruit that will fill the gaps; identify and implement solutions that mitigate risk; develop corrective action plans as neededParticipate in training sessions for providers and staff as appropriateSupport the contracting requirements of the corporation for geographic regions and productsKnowledgeable of federal and state laws and regulations pertaining to provider contractingAssist with development and review of payment policies and provider notificationsAs requested, become a Subject Matter Expert on specific provider typesMentor junior contractors, as requestedPerform any other job duties as requestedEducation and Experience:Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is requiredMaster’s Degree is preferredMinimum of three (3) years of Healthcare experience, to include one (1) year of work experience in managed care provider relations or provider contractingManaged care experience is highly preferredCompetencies, Knowledge and Skills:Intermediate proficiency level with Microsoft Outlook Word, and ExcelKnowledge of Provider Network Management Processes & ServicesAbility to manage and prioritize multiple tasks, promote teamwork and fact-based decision makingStrong negotiation skillsEffective oral and written communication skillsCritical listening and thinking skillsTraining/teaching skillsTime management skillsLicensure and Certification:Must have valid driver’s license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver’s license record check and verified insurance. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated.To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.Working Conditions:General office environment; may be required to sit or stand for extended periods of timePerform reasonable travel, up to 30% to fulfill the duties of the positionCompensation Range:$69,400.00 - $111,000.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.Compensation Type:

SalaryOrganization Level Competencies:Create an Inclusive EnvironmentCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.

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