Manager Provider Contract Development

Company :

Job Description : 

JOB SUMMARY

This job manages the business process of contract management with internal departments.  The incumbent oversees the staff and facilitates the development/editing and interpretation of provider contract language.  Accountable for all contracts including multi-market facility and ancillary agreements as well as value based contracts.  Works with the Organization's internal legal department to develop recommended contracting strategies and interpret contract language and risk. Provides support to markets regarding any terminations including any required regulatory reporting. 

This role is hybrid with 3 days a week onsite if you live within 50 miles of a Highmark office.
ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
• Manage the contract development team and provide process guidance for the development of facility, ancillary, and professional multi-market templates for commercial and Medicare Advantage lines of business covering WPA, CPA, NEPA, statewide PA professional, WV, and DE.  
• Serve as the lead in managing contracting life-cycle management (CLM) software; primary liaison to CLM vendor; plan contract integration into the CLM solution; and ensure CLM solution and process meet all regulatory compliance requirements.
• Manage the contract development team and provide process guidance for the development of value-based reimbursement agreements.
• Provide support to the markets in all provider terminations including managing staff in the development of termination notices and serve as the primary contact to applicable regulatory agencies to ensure all reporting obligations and member transition obligations are met.
•  Oversee and manage staff in reviewing provider changes including asset sales and mergers.
•  Assign and provide guidance to staff in market contract language risk assessments including the interface with legal for joint risk assessments.  
• Other duties as assigned.

EDUCATION

Required

• Bachelor's Degree in Business Administration/Management, Procurement or Health Administration

Substitutions

• 6 years management experience or 6 years of contract management experience

Preferred

• Master's degree in Business

EXPERIENCE

Required

Any one of the following

• 5 - 7 years in the Healthcare Industry
• 5 - 7 years in Management
• 5 - 7 years in Contract Development
• 1 - 3 years in Legal

Preferred

• None

LICENSES AND CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Contract Management
• Business Process
• Operations Management
• Procurement Contracts
• Legal Analysis

Language (other than English)

None

Travel Required

None

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Never

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Occasionally

Lifting: 10 to 25 pounds 

Rarely

Lifting: 25 to 50 pounds 

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures a