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Manager, Contracting

Manager, Contracting

Job Locations 
US-VA-Glen Allen
Job ID 
2018-4478

Job Description

Overview

This position is responsible for managing physician contracting within the network development department by developing an extensive expertise in the data systems specific to the network development department. This position requires an expertise in the analysis of contract language, claims and provider data.

Responsibilities

  • Develop and maintain contracting Policies and Standard Operating Procedures (SOPs).
  • Collaborate with the Network Development Analytical team to automate and implement process improvements.
  • Establish and maintain relationships with healthcare providers.
  • Project leader for contracting initiatives that impact the department.
  • Responsible for the development of an effective delivery system including but not limited to: Hospitals, PCPs, Specialists, LTSS, SUD, Ancillary and Other provider types.
  • Negotiate financial terms with providers including per diem rates, global rates, incentive/risk arrangements and capitation contracts.
  • Maintain provider contracts and ensure compliance of contracts with state and federal
  • Collaborate with Director, Network Development to set strategy for the contracting unit and spearhead major initiatives as needed.
  • Development and coordination of provider network for expansion into new localities for all products in accordance with regulatory adequacy guidelines.
  • Ensures prompt and efficient response to provider or provider related issues with appropriate, objective documentation of concerns, recommendations of resolution, monitoring and re-evaluation.
  • Supervise staff to achieve necessary goals within the organization. Mentor and train staff on new initiatives that impact the department.
  • Review Third Party Agreements prior to final sign-off.
  • Perform other managerial duties as required.

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor’s degree in Business or Information Systems

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Excellent understanding of Medicaid healthcare insurance markets the HMO concept and business operations.
  • Previous experience in hospital or physician contracting.
  • Exceptional organization skills
  • Excellent oral & written communication skills
  • Demonstrated leadership skills.
  • Ability to manage multiple projects while meeting deadlines and achieving business goals.
  • Ability to supervise staff and promote successful performance.

WORK BACKGROUND/EXPERIENCE

  • Two (2) years management experience

PHYSICAL REQUIREMENTS

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

 

About Us 

Virginia Premier 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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