CONTRACT DEVELOPMENT MANAGER II – NETWORK CONTRACT DEVELOPMENT MGR (PROVIDER NEWTWORK HEAD HUNTERS) in Boise, ID at Beacon Health Options

Date Posted: 7/5/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Contract Development Manager II with advance scouting, recruiting and sourcing experience to join our team in the West Region. The Contract Development Manager II leads all territory network development and contract management activities for a growing and complex managed behavioral health care organization.   The position is responsible for network development, recruiting for new business, contracting, and rate negotiations for their assigned territory and or state.  Duties include identifying and contracting new/ re-contracting existing providers around Beacon’s need for services, negotiating rates, drafting provider services and facility agreements, sending and receiving credentialing applications, overseeing the resolution of language changes and securing executed contracts with providers, developing recruitment plans and reports and ensuring rates negotiated are within established guidelines.

Position Responsibilities:

  1. Negotiates rates and contract terms with currently contracted providers and facilities.

  2. In conjunction with internal and external stakeholders, secure executed agreements with identified out of network providers for inclusion in the Beacon Health network.

  3. Performs reimbursement analysis on providers/facilities that are outside of the targeted rate schedule or performance standards and develop strategies for cost reductions, member needs and increasing quality.

  4. Has a keen understanding of Quest or other Geo Access information to ensure that we are targeting the right areas of need and addressing any gap areas quickly and efficiently.

  5. Identifies opportunities for cost savings and process improvements related to the contracting process.

  6. Review, draft and document suggested language changes, and oversee resolution of all proposed changes to the provider services agreement.

  7. Ensures that Contract Language is in compliance with plan agreements and within all state and federal regulatory and NCQA standards.

  8. Gather, review and submit credentialing applications, as required, for network development and management.

  9. Provides general support to all network development activities and support Director with implementation requirements.

  10. Strategizes with other members of the management team and client/plan to ensure access and availability of providers meets current standards.

  11. Collaborates with other departments to address and resolve operational issues as related to negotiated contract language.

  12. Prepares reports and analyze data as directed by the Director of Provider Relations or other members of the management team.

  13. Adheres to all Beacon policies and procedures and standards of operations.

  14. Completes all required and assigned trainings.

  15. Attends all mandatory company or department meetings.

  16. Reports to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.

  17. Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.

  18. Acts as a mentor to junior team members by leading by example and guiding with a sense of integrity and team work.

  19. Assists management with identifying opportunities for staff improvement, high performing team members, and training needs of team members.

  20. Assist team members and offers suggestions to improve processes, culture, or work environment.

  21. Performs special projects and other duties as assigned and required.

Position Requirements:

Education: High School diploma or GED required.  Bachelor’s degree preferred or equivalent experience in health care field.

Licensure:  N/A

Relevant Work Experience:  

At least 3 years’ experience rate & contract language negotiation to include facility and higher level of care experience; In-depth knowledge of all facility, and some provider reimbursement methodologies- behavioral health experience a plus.

Knowledge of managed care contract requirements to include state and federal regulatory requirements for Medicare and Medicaid plans and CMS guidelines.

Advance Scouting, Recruiting and Sourcing skills required

Knowledge, Skills & Abilities:

Knowledge of managed care contract requirements to include state and federal regulatory requirements for Medicare and Medicaid plans and CMS guidelines.

Must be flexible to travel & reside in the following states: (West Region: WA, OR, CA, AK, ID, NV, AZ, UT WY, MT & NM)

TO APPLY

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

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