Physical Health PN Contract Manager (Remote)

LOCATION: Remote - this is a home based, virtual position that operates within the hours of 8:30am-5:00pm EST. Must live in North Carolina or within 40 miles of the NC border.

GENERAL STATEMENT OF JOB

The Physical Health PN Contract Manager identifies and contract with physical health providers to develop the physical health provider network yielding a geographically broad access, stable network that achieves objectives for unit cost performance, and produces an affordable and predictable product for members and business partners. This role evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.

The Physical Health PN Contract Manager initiates, negotiates, and executes physician, hospital, ancillary and/or other provider contracts and agreements for Vaya Health. This position works on problems of diverse scope and complexity ranging from moderate to complex. Strategically approach the provider community and prioritize network needs both quantitatively and qualitatively.

ESSENTIAL JOB FUNCTIONS

Network Management

• Responsibilities include establishing and maintaining strong business relationships with Health Systems (Hospital, Physician and Ancillary providers), and ensuring the network composition includes an appropriate distribution of provider specialties.
• Negotiate and re-negotiate provider organization contract terms, payment structures, and reimbursement rates to providers.
• Analyzes financial impact of contracts and terms.
• Maintains contracts and documentation within a tracking system.
• Advises executives to develop functional strategies (often segment specific) on matters of significance.
• Function as the single point-of-contact for all on-going contractual and service issues as needed by providers
• Facilitate provider education and training to increase provider familiarity and satisfaction with Vaya's systems and strategies
• Create and review trend analyses and summaries for decision-making purposes
• Interface with Vaya network and department leaders to align provider development needs and projects
• Study and design innovative programs to create and enhance access to care, such as jail diversion, veterans and under-served populations,
• Work with provider organizations and community stakeholders to successfully implement new programs and improve member access to care.
• Apply network configuration and incentive-based payment models as appropriate to improve quality and efficiency
• Assist others to resolve highly complex or unusual business problems that affect major functions or disciplines
• Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.

KNOWLEDGE OF JOB

• Proficiency in analyzing, understanding, and communicating financial trends; strong customer service skills; excellent verbal and written communication skills
• Ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand
• Ability to understand and interpret complex information from others, including but not limited to reimbursement policy standards; exceptional Business Acumen
• Ability to present to varied audiences
• Ability to manage multiple priorities in a fast-paced environment; high level of proficiency in Microsoft Office applications; prior demonstrated success in provider relations with large provider groups and/or ancillary providers
• Experience with multiple provider relations methodologies such as RVRBS, flat rates, case rates, per diems and tiered rates based on the intensity of service
• Expert level of knowledge of CMS reimbursement methodologies

EDUCATION & EXPERIENCE REQUIREMENTS

Bachelor's degree in Public Administration, Business or Human Services required. Master's degree preferred. Must have 2-5 years of relevant network management experience including contracting with Healthcare Providers and network administration in a healthcare company.

Preferred Experience:

• Extensive provider contracting skills, including contract preparation and implementation, financial analysis, and rate proposal development preferred.
• Experience with Medicaid and Value Based Contracting utilizing financial modeling in making rate decisions preferred
• Bilingual in Spanish or Chinese preferred but not required

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENT: Must reside in North Carolina or within 40 miles of the NC border.

SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open until filled.

APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.

Vaya Health is an equal opportunity employer.