Provider Relations and Contracting Manager - Wisconsin
- Compensation
- Not disclosed
- Location
- Bloomington, MN, United States
- Work setup
- Not specified
- Seniority
- Not specified
- Employment
- Contract
- Experience
- Not specified
- Category
- Not specified
- Posted
Skills
Must have
- Bachelor’s degree in health care administration, business administration or other relevant field.
- Minimum of seven years experience working in the health care industry with three years working in a provider relations/provider administrative role.
- Previous experience in a management position, independently responsible for planning and development of a key company function.
- Strong analytical and financial modeling skills.
- Ability to develop and evaluate contracting strategies.
- Strong oral and written skills with the ability to make effective group presentations and consensus building.
- Excellent team leadership skills with a sound level of interpersonal effectiveness.
- Ability to work independently, making independent decisions as they relate to the successful relationships with providers, consistent with HealthPartners goals.
- Must reside in eastern Wisconsin, near the Milwaukee area, as the position will primarily support providers located in this region.
- Travel throughout eastern and central Wisconsin will be required to support provider relationships and business needs.
- Occasional travel to the HealthPartners corporate office in Bloomington, Minnesota will also be required.
Nice to have
- Strong financial and systems background.
- Previous experience in provider contract negotiations.
- Previous experience in health care industry.
- An additional two years experience in network development in specific products, e.g. workers compensation.
Full description
HealthPartners is hiring a Wisconsin Based Manager of Provider Relations and Contracting.
POSITION PURPOSE:
Manage HealthPartners strategic relationships with Wisconsin providers including: provider contracting, financial analysis, operations management, development of strategic partnerships and coordination with HealthPartners and Contracted Medical Groups.
Overall responsibilities include:
- Establish and maintain positive contractual and strategic relationships between HealthPartners and its network of providers in eastern Wisconsin.
- Develop and implement network contracting strategies consistent with HealthPartners overall objectives.
- Develop and implement sound reimbursement methodology for Wisconsin providers.
- Negotiate contract terms with eastern Wisconsin providers
- Work with government programs management to ensure compliance with Medicare product requirements and regulations.
- Create product specific networks as directed by HealthPartners indicatives.
- Coordinate communications between the Health Plan, primary care, specialty and institutional providers.
- Manage the day-to-day operational needs related to eastern Wisconsin providers.
- Supervise and mentor direct reports, including service specialists and contract consultants when applicable.
- Perform project management duties for a variety of projects designed to enhance strategic contracted partnerships and services for the Health Plan, contracted clinic systems, HealthPartners Medical Group and Regions Hospital.
- Investigate, mediate and resolve inquiries regarding the delivery of care by providers.
- Provide support to the Quality Utilization Management Department in analyzing provider trends and developing action plans to effect change
- Future responsibility of the supervision of staff, including having the authority to hire, transfer, lay off, promote, discipline and discharge, train, reward and review performance of employees. Ensures compliance to organizational and departmental policies and procedures.
ACCOUNTABILITIES:
Independently manage and supervise the administrative functions relating to Wisconsin contracted providers, including network strategy development, financial analysis, negotiations, contract drafting, contract monitoring, establishing provider relations and communications.
Independently manage and supervise the implementation of provider contracts. Develop systems, policies and procedures to communicate and ensure the successful implementation of contracts by the following internal departments: Claims, Accounts Payable, Member Services, Clinic Operations, Support Services, Quality Utilization Management, Referral Secretaries, Government Service, Pharmacy Care Network, Sales and Marketing, and Contracting.