St. Lukes Health Plan in Boise, ID is seeking a Manager of Provider Services & Contracting to join our Heqlth Plan team.

The Manager of Provider Services & Contracting establishes and maintains contracts with healthcare providers to optimize the value of the Health Plan's statewide delivery network. Responsible for successful contract execution and implementation, network development, and maintaining compliance with legal and regulatory standards. Manages provider relations activities for the Health Plan, facilitating communication and collaboration with provider groups, network teams, enterprise subject matter experts, and various stakeholders to swiftly address and resolve issues. Collaborates with leaders to cultivate proactive relationships with key providers in each market, ensuring optimal provider quality and satisfaction levels are consistently achieved.

• Leads Health Plan provider contracting efforts with input from leaders across the Health Plan to ensure alignment with broader business strategies and key initiatives.
• Manages the Health Plan's overall contracting strategy, including applicable negotiations with providers, facilities, and networks. Analyzes financial impact of contracts and terms.
• Oversees provider-related issue resolution. Facilitates problem solving with internal stakeholders and provider services staff to achieve fair and timely resolution with providers.
• Develops thorough knowledge of system capabilities and resources related to analytics, Tapestry, and other supporting systems.
• In partnership with clinical and compliance leadership, actively supports denial outreach, outlier identification, non-responder engagement, and appeals initiatives with providers. Additionally, initiates clinical education meetings with providers to enhance understanding and collaboration in these areas.
• Maintains contracts and documentation within contract management system.
• Collaborates with Configuration Analyst to implement contract and performs audit on contracting configurations to ensure accuracy and compliance.
• Develops and implements policies, procedures, and training materials for Providers. Oversees provider training events and activities.
• Oversees Network Adequacy reporting and documentation for regulatory requirements.
• Responsible for full employment life cycle for staff to include hiring, termination, performance management, coaching, training, and mentoring.
• Performs other duties and responsibilities as assigned.

Qualifications:

• Education: Bachelor's Degree or experience in lieu of degree.
• Experience: 5 years' experience.
• Licenses/Certifications: None

At St. Lukes, caring for people in the communities we serve is our mission and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Virgin Pulse Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.

St. Lukes is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.