Virginia Premier Health Plan, Inc.

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Manager, Third Party Contracting

Manager, Third Party Contracting

Job Locations 
US-VA-Glen Allen
Job ID 
2017-3973

Job Description

Overview

This position is responsible for setting and implementing the strategy for managing third party contracting for all health plan products and services. The incumbent implements the strategy by developing and maintaining internal and external relationships that result in high-quality, cost-effective and efficient services.

 

Responsibilities

  • The 3rd Party Contracting Manager will oversee the successful coordination, negotiation and implementation of sub-contracted vendor contracts and third party agreements across all Medicare, Medicaid and other health plan products. 
  • Develops and administers the contract review process to include risk monitoring plans and protocols to sustain transparency into all third-party contracts, resolves any risk-related issues, and leads the contract renewal and termination process and communicates to internal business owners. 
  • Reviews contract provisions and makes recommendations to internal and external teams as to needed modifications to contract and/or insurance program. 
  • Ensures contracts are in compliance with all Medicaid, Medicare and internal policies and procedures. 
  • Works closely with all operational areas to ensure contract proposal is compliant with the organization’s business needs. 
  • Demonstrated ability to collaborate effectively with cross-functional management staff and key business customers to achieve business goals.
  • Assist with the development and implementation of contract negotiation strategies for the health plan.  
  • Collaborate with the Director of Network Development to set strategy for the department and spearhead major initiatives as needed. 
  • Attract, train, develop, manage and retain high-performing staff to achieve necessary goals within the organization. 
  • Partner with the Delegate Oversight Team (DOT) to ensure proper SLAs and KPIs are incorporated into sub-contracted vendor agreements. 
  • Participates in the implementation of subcontracted vendors and serves as a liaison between the subcontracted vendor and the Network Development department. 
  • Works with Health System legal team and establishes processes for secondary review. 
  • Performs bi-annual training for the organization on third party contract review process. 
  • Develop and maintain contracting Policies and Standard Operating Procedures (SOPs). 
  • Perform other managerial duties as required.


Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor’s degree in Business Administration, Healthcare Management or related field. Master’s degree preferred or Paralegal certification preferred

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Demonstrated success participating in high performance vendor management team
  • Ability to be self-sufficient and proactive
  • Excellent understanding of Medicare and Medicaid healthcare insurance markets, the HMO concept and business operations
  • Exceptional organization skills with attention to detail
  • Excellent oral & written communication skills
  • Demonstrated leadership skills
  • Ability to manage multiple projects while meeting deadlines and achieving business goals.
  • Ability to supervise staffs and promotes successful performance
  • Strong customer focus

WORK BACKGROUND/EXPERIENCE

  • 3-5 years management experience preferred

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

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