Contract Manager

Position Summary

The Contract Manager is responsible for managing Client Provider Networks through contracted health plans, primary care physicians and specialists, key hospitals, ancillary and any other necessary providers to support the Client Network’s goals including a healthy population, while managing costs and achieving high quality measures.

RESPONSIBILITES-DUTIES

• Coordinate with SVP Contracting and Contract Director
• Performs analysis of contracting needs, including assessment of claims and utilization data, to identify areas for new and re-negotiated contracts
• Develop and maintain provider contracted networks and execute negotiated contracts that support network needs
• Review implementation to ensure contract is appropriately administered
• Develop and maintain strong, cost effective and mutually supportive relationships with key providers and clients
• Ensure timely administration/implementation of contract terms
• Act as technical resource on contract related issues
• Maintain internal contract database for management of accurate data and complete contract detail
• Advise other departments of new contracts and amendments, including updating of all internal systems and processes
• Research, analyze and resolve complex problems dealing with hospital shared risk pool, claims, appeals, authorizations and eligibility issues, as it pertains to the contract, within the appropriate time limits
• Use, protect, and disclose all patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Oversees the process for maintaining and managing letters of intent (LOI) from prospective providers
• Assist with health plan documents and DOFR’s, as needed
• Maintain contract templates and amendments and ensures templates are compliant with State and Federal law, internal operations, products and financial requirements
• Represent department in internal and external audits
• Continually seek out opportunities for functional improvement and improved business processes
• Participate in regularly scheduled Joint Operations Committee meetings (JOCs)
• Participate in interdepartmental meetings and selected committees and substitute for Contract Negotiators on an as needed basis
• Perform other duties as assigned
  
  

Education & Experience Requirements

• Bachelor’s Degree
• Minimum 3-years of recent experience in healthcare contracting
• Strong computer skills (word processing, spreadsheets, database access, Outlook, EZCAP)
• Excellent verbal and written abilities
• Ability to prioritize and multi-task while paying attention to detail
• Ability to work in a fast-paced environment while easily adapting to change
• Strong analytical and problem solving skills
• Ability to meet deadlines
• Big Thinker. Sees the big picture and looks for process improvement
• Project professionalism and demonstrate ethical conduct and good judgment at all times
• Ability to travel as required
  
  

Amm Benefits

When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first:

• Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
• Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
• Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
• Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.
• Career Development: Tuition reimbursement to support your education and growth.
• Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun!