Provider Contract Manager

Organizational Background:

Northeast Health Partners (NHP) is a mission-driven organization dedicated to delivering high-quality, integrated healthcare services to communities across northeastern Colorado. As the Regional Accountable Entity (RAE) for Region 2 under Health First Colorado (Medicaid), NHP oversees the coordination and delivery of physical and behavioral health services for Medicaid members. We ensure a full spectrum of high quality, whole-person care, promoting member education, preventive services, care coordination, and evidence-based treatments are core to our mission.

Position Summary:

Reporting to the Provider/Community Relations Director, this position supports the organization’s provider network by managing Medicaid contracts with physicians, monitoring behavioral health provider contracts, assessing network adequacy through time and distance standards, conducting outreach to increase the physician and specialist provider network, onboarding new physicians, maintaining the network directory, supporting providers with questions related to contracts, and ensuring contractual compliance for the provider network. This position also oversees behavioral health contracts and network adequacy standards. This experience will include thorough knowledge of contracting with physicians and physician groups, integrated delivery systems, health systems, and ancillary providers using various payment methodologies including fee-for-service and value-based / risk-based contracts. This position is a central component in supporting organizational operations to meet organizational needs to improve the health of Region 2 Medicaid members.

Must reside in the State of Colorado or be willing to relocate prior to position start date.

Duties Performed:

• The Provider Network manager will oversee the network of contracted physicians based on the organization’s contract with the state.
• Develop, oversee, manage, and submit the quarterly Network Adequacy report; ensuring NHP is meeting network adequacy requirements.
• Submit necessary paperwork to the state when network changes may negatively impact access to care.
• Maintaining relationships and all provider relations activities in assigned geographical area
• Negotiating and renegotiating contracts with providers as assigned
• Work with Provider Relations to address network deficiencies
• May provide training to providers on various topics related to contracting, credentialing, and billing
• Duties include physician contract management, maintaining an accurate and up-to-date provider directory, assessing network adequacy through geomapping/geoaccess, program and project management of initiatives, data collection and analysis for both impacts and corporate and state-level reporting; adhering to state and contract deadlines.
• Develop project reports as required to ensure timelines and the content needs of deliverables are met.
• Communicate with staff, clients, and leadership on progress; developing long and short-term goals in alignment to organizational strategies, delegating tasks and tracking progress, and serving as a main point of contact for project initiatives.
• Serve as a key collaborator with the Contract Manager to ensure contractual obligations are being met, and help develop initiatives to support deficiencies.
• Analyze data, identify gaps in data and new data sources, and partner with external stakeholders to ensure projects are carried out and completed on time.
• May conduct regional research on community capacity, available resources, and needs assessments. Leverage such resources to help develop and execute targeted interventions aimed at improving health outcomes.
• Ability to routinely travel throughout Colorado and Region 2.
• Perform other duties as assigned.

KNOWLEDGE/SKILLS/ABILITIES

Education/Credentials/Experience:

• Bachelor's degree from an accredited college or university in Business Administration, Public Health, Public Administration, Healthcare Administration, or other closely related field.
• Bachelor's degree must have 7 years negotiating provider contracts including physician / provider group contracts with multiple payment methodologies including value-based risk.
• Master's degree 3 minimum of 3 years experience.

Knowledge of:

• Provider servicing experience
• Solid ability to navigate either Google or MS Suite of products
• Experience and relationships in the local market
• Provider contracts and fee schedules. Experience with Medicaid is a plus.

Skills/ Abilities to:

• Ability to make quick, independent decisions
• Mutually beneficial negotiation skills
• Strong project management skills
• Attention to detail
• Ability to analyze financial and performance reports and identify trends/variances, “Big Picture” thinking, and understanding impacts of decisions on network as a whole
• Extremely effective oral/written communication skills

Working Conditions:

Work is primarily performed in a standard office environment; however, a hybrid work model may be offered, blending in-office and remote work opportunities based on organizational needs and job requirements. Some meetings will occur at locations outside of the usual work location, including the use of conference and electronic meeting platforms (e.g., Zoom, GoToMeeting). All positions require travel within the counties NHP serves.

SALARY RANGE:

Salary Range: $70,0000.00 - $105,000.00. The base compensation represents the entry point of the range. Actual salaries will vary and may be above or below the range based on factors including but not limited to location, experience, education, licensure, and performance.

Job Type: Full-time

Pay: $70,000.00 - $105,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Health savings account
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Application Question(s):

• Do you reside in the State of Colorado or are you willing to relocate prior to position start date?

Work Location: Hybrid remote in Greeley, CO 80631

Salary : $70,000 - $105,000