Manager, Provider Contracting (St. Louis, MO)

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Manager, Provider Contracting is accountable for the staff responsible for the strategy, development, execution and management of alternative contracting, including, but not limited to, total cost of care (TCOC) contracting negotiations, bundles, alternative payment arrangements and network development.

Provider contracting is the foundation for development of alternative payment arrangements as well as the financial strategy that moves reimbursement from total fee for service to risk sharing with providers. This type of contracting is key in developing products and financial strategies around provider relationships and supports the organization's market strategies and financial objectives.

The contracting model for alternative arrangements is complex and could contain both cost/utilization factors as well as quality measurement performance. The incumbent is required to identify and cultivate key provider relationships for consideration of differential payment terms. The Manager, Provider Contracting requires an ability to think strategically and have a thorough understanding of the financial modeling and impacts in the execution of alternative arrangements. Performs other duties as assigned.

Key Accountabilities

• Lead Contract Management Function
  
  
  
  • Oversees contract managers to successfully execute contracting arrangements, which include alternative payment terms, with providers in a timely, accurate fashion
  • Provides first level of escalation during contract negotiations
  • Oversees network development activities
  • Provides leadership to contracting staff by communicating organizational strategy and actions to execute strategy
  • Coordinates network contracting activities with Provider Finance, Operations and Legal in understanding data analytics, operational compatibility and sound legal instruments
  
  
  
  

• Manage Department Activities
  
  
  
  • Establishes and improves processes and policies and procedures
  • Provides staff guidance on negotiating contracts in collaboration with appropriate internal areas
  
  
  
  

• Provider Relations
  
  
  
  • Maintains positive working relationships with Medica's key providers
  
  
  
  

Required Qualifications

• Bachelor's degree in Healthcare, Finance, or Economics, or equivalent experience in related field
• 5 years of work experience beyond degree in contract negotiations and healthcare

Skills and Abilities

• Proven track record as a team leader with staff management skills
• Excellent communication (written, verbal and presentation) skills
• Proven track record of cultivating and maintaining effective, collaborative external relationships where the parties trust information that's conveyed
• A proven track record as a successful contract negotiator for health care services, provider or health plan
• Flexibility and creativity in developing effective contracting terms
• Knowledge of provider contracting components and strategies such as but not limited to risk-based contracting, financial models, operational impact and data analytics
• Demonstrated understanding of complex financial arrangements and quality programs across health care products
• Strong financial, analytical and problem solving skills, and understanding of legal documents
• Strategic-thinking skills with the ability to conceptualize a wide range of scenarios and the ability to analyze each scenario to come up with the most viable option
• An understanding and appreciation for standardizing processes to generate efficiencies and improve service levels

This position is an Office role, which requires an employee to work onsite at our St. Louis, MO office, on average, 3 days per week.

The full salary grade for this position is $98,400 - $168,600. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $98,400 - $147,525. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.