What are the responsibilities and job description for the Health Partner Network Manager position at CareSource?
Job Summary :
The Health Partner Network Manager executes the Health Partner contracting strategy, develops contract provisions based on cost, quality / analysis and monitors key metrics for the assigned Market.
Essential Functions :
- Create, execute and administer value based reimbursement (VBR) strategies as directed
- Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting initiatives
- Responsible for provider recruitment, contracting and initiating the loading and credentialing processes
- Responsible for following up / auditing providers as they proceed through the loading process to ensure accuracy
- Create contract language and review with legal to develop approved contract templates specific to the assigned Market and within the established corporate guardrails
- Analyze financial data and establish rates in collaboration with Provider Contracting leadership and Finance
- Negotiate and re-negotiate hospital, ancillary, physician and behavioral health contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
- Build networks to support new products within the market and on-board new providers
- Responsible for complying with all regulatory requirements
- Perform gap analysis to ensure no gaps and / or sanctions occur; identify potential providers to recruit that will fill the gaps; identify and implement solutions that mitigate risk; develop corrective action plans as needed
- Participate in training sessions for providers and staff as appropriate
- Support the contracting requirements of the corporation for geographic regions and products
- Knowledgeable of federal and state laws and regulations pertaining to provider contracting
- Assist with development and review of payment policies and provider notifications
- As requested, become a Subject Matter Expert on specific provider types
- Mentor junior contractors, as requested
- Perform any other job duties as requested
Education and Experience :
Competencies, Knowledge and Skills :
Licensure and Certification :
Working Conditions :
Compensation Range :
70,800.00 - $113,200.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly / salary) :
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
Salary : $70,800 - $113,200
