Sr. Network Expansion & Contract Manager

tango manages the home health benefit for major insurance plans with a focus on Medicare Advantage and managed Medicaid members. We review home health care referrals for appropriateness, then set up services with multiple agencies to provide the care needed for patients. On an ongoing basis, we provide review and oversight of clinical care and determine further authorizations. Our delegation agreements often include credentialing home health agencies and paying home health claims.

Tango is seeking a seasoned healthcare professional to serve as the Senior Network Expansion & Contract Manager, reporting to the Regional Director of Contract Management. This pivotal role focuses on supporting the strategic growth and optimization of Tango's home health provider network. Responsibilities include leading targeted provider recruitment efforts, conducting initial network modeling, delivering provider education, managing complex contract negotiations, and driving value-based arrangement (VBA) initiatives to ensure network adequacy and alignment with organizational goals.

This position is pivotal in negotiating contracts, scaling net new provider networks across multiple geographies, and enhancing network performance through value-driven contracting, collaborative provider engagement, and innovative strategies aimed at securing favorable agreements to maximize profit margins.

Job Responsibilities

• Network Modeling:

• • Utilize desired platform to analyze and model provider networks, ensuring alignment with regulatory adequacy requirements and strategic market expansion goals.
  • Develop and execute recruitment strategies informed by network modeling insights, focusing on cost-effective and high-quality providers to strengthen network adequacy.
  • Identify network gaps by evaluating provider data accuracy, location, and specialty tags to improve network accessibility and performance.

• Provider Recruitment and Network Adequacy:

• • Facilitate in-person or virtual meetings with provider agencies to highlight Tango's value propositions, market presence, and contracting initiatives, fostering engagement and alignment with strategic goals
  • Recruit and educate out-of-network providers on Tango’s business model to ensure alignment with internal and health plan network adequacy goals while expanding access in key markets.
  • Educate providers about Tango's value-based program, including qualifying metrics, performance expectations, and the pathways to earning incentives.

 Contract Negotiation and Management:

• • Lead the negotiation of fiscally responsible fee-for-service, episodic, PDGM and value-based contracts with language that aligns with Tango’s business model, payer agreements, and mission to provide high-quality home health and post-acute services.
  • Ensure provider contracts meet Tango’s compliance policies, Medicare guidelines, and State and Federal laws and regulations.
  • Negotiate and execute contract amendments, and renegotiation requests.
  • Manage complex contract negotiations to meet strategic network adequacy and growth objectives.

• Value-Based Arrangement Management:

• • Track, monitor, and manage value-based arrangements tied to provider contracts, in collaboration with Network Analyst, Finance and other internal teams.
  • Participate in the collaboration of developing strategies and reporting mechanisms for value-based performance, enabling providers to access real-time performance monitoring and insights.
  • Provide ongoing education to network agencies and internal teams on value-based metrics, performance expectations, and tango’s VB goals.

• Performance Monitoring and Reporting:
  • Develop, monitor, and report on key network performance indicators to support network optimization, recruitment, and adequacy.
  • Propose and execute strategies to improve network performance metrics and achieve Tango’s objectives.
  • Conduct quarterly performance reviews with contracted providers on contract compliance and address areas for improvement.
• Interdepartmental Collaboration and Support:
  • Partner cross-functionally with credentialing, provider specialists, finance, and other internal teams to ensure contracts are accurately loaded and maintained.
  • Provide expertise and guidance to internal teams on contract and value base-related matters.
  • Identify opportunities to enhance and streamline contracting processes.
• General Responsibilities:
  • Carry out network management assignments and other duties as directed by the management team when active network requirement is not required.
  • Review and analyze contract terms, identifying potential risks and opportunities.
  • Provide oversight of Contract Administrators to support day-to-day administrative tasks, ensuring efficient and accurate contract management processes.

Ideal Candidate:

• Ability to leverage network modeling tools to evaluate and optimize provider networks.
• Excel in identifying gaps, aligning strategies with organizational goals, and ensuring compliance with health plan adequacy standards while driving targeted recruitment efforts
• Proven expertise in value-driven payment concepts and VBA management.
• Extensive experience in navigating complex ancillary provider contract negotiations.
• Highly organized with strong written and verbal communication abilities.
• Exceptional interpersonal and relationship-building skills.
• Ability to build trust and rapport with partners and stakeholders, both externally and internally.
• Strong problem-solving skills with the ability to effectively address and resolve challenging situations.
• Eagerness to learn and adapt in a dynamic, fast-paced organization.
• Proficiency in Microsoft Excel and ability to analyze large datasets.
• In-depth understanding of value-based metrics, gap closures, and network adequacy strategies.
• Experience building, monitoring, and utilizing performance and VBA reports.
• Excellent organizational and time management skills.
• Meticulous attention to detail and a commitment to excellence.

Requirements:

• Requires a BA/BS
• Masters preferred
• Minimum 3 years experience in an ancillary provider contracting role on a State level; Multi-State level preferred
• Must have knowledge of home health agency contract structure
• Must have knowledge of PDGM payment modeling
• Must have experience with alternative payment models and value-based arrangements
• Must have a strong understanding of home health agency credentialing process
• Must have a strong working knowledge of home care’s role in the post-acute care space
• Ability to travel on a quarterly basis, at minimum

 Job Type 

• Full-time 

tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.