Manager Provider Contract Development

Description

JOB SUMMARY

This job manages the business process of contract management with internal departments.The incumbent oversees the staff and facilitates the development / editing and interpretation of provider contract language.

Accountable for all contracts including multi-market facility and ancillary agreements as well as value based contracts.

Works with the Organization's internal legal department to develop recommended contracting strategies and interpret contract language and risk.

Provides support to markets regarding any terminations including any required regulatory reporting.

This role is hybrid with 3 days a week onsite if you live within 50 miles of a Highmark office.

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to including, but not limited to : involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
• Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary;

may have budgetary responsibility and authority.

• Manage the contract development team and provide process guidance for the development of facility, ancillary, and professional multi-market templates for commercial and Medicare Advantage lines of business covering WPA, CPA, NEPA, statewide PA professional, WV, and DE.
• Serve as the lead in managing contracting life-cycle management (CLM) software; primary liaison to CLM vendor; plan contract integration into the CLM solution;

and ensure CLM solution and process meet all regulatory compliance requirements.

• Manage the contract development team and provide process guidance for the development of value-based reimbursement agreements.
• Provide support to the markets in all provider terminations including managing staff in the development of termination notices and serve as the primary contact to applicable regulatory agencies to ensure all reporting obligations and member transition obligations are met.
• Oversee and manage staff in reviewing provider changes including asset sales and mergers.
• Assign and provide guidance to staff in market contract language risk assessments including the interface with legal for joint risk assessments.
• Other duties as assigned.

EDUCATION

Required

Bachelor's Degree in Business Administration / Management, Procurement or Health Administration

Substitutions

6 years management experience or 6 years of contract management experience

Preferred

Master's degree in Business

EXPERIENCE

Required

Any one of the following

• 5 - 7 years in the Healthcare Industry
• 5 - 7 years in Management
• 5 - 7 years in Contract Development
• 1 - 3 years in Legal

Preferred

None

LICENSES AND CERTIFICATIONS

Required

None

Preferred

None

SKILLS

• Contract Management
• Business Process
• Operations Management
• Procurement Contracts
• Legal Analysis

Language (other than English)

None

Travel Required

None

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Never

Works primarily out-of-the office selling products / services (sales employees)

Never

Physical work site required

Lifting : up to 10 pounds

Occasionally

Lifting : 10 to 25 pounds

Rarely

Lifting : 25 to 50 pounds

Rarely

Pay Range Minimum : $78,900.00

$78,900.00

Pay Range Maximum : $146,000.00

$146,000.00

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation / gender identity or any other category protected by applicable federal, state or local law.

Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation / gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities / Women / Protected Veterans / Disabled / Sexual Orientation / Gender Identity ()

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