Provider Contracting Specialist, Principal

Your Role

The Provider Network Management team consists of Provider Relations and Contracting in Northern California. The Provider Contracting Specialist, Principal will report to the Director, Provider Contracting. In this role you will be responsible for managing contract negotiations for select providers in Central and Northern California. The job entails comprehensive management of Medical Group/IPA and Hospital provider networks in the assigned service areas. Additionally, this role will be instrumental in driving strategic initiatives to support company objectives to achieve growth and maintain a strong market position and positive reputation in the market. 

Your Work

In this role, you will:

• Manage contract negotiations for providers, including IPA/Medical Groups, PPO physicians, and hospitals for all products
• Participate in a cross-functional team to implement initiatives to help manage the total cost of health care across the assigned region
• Collaborate closely with Medical Management, Provider Relations, Network Analytics, and Sales to meet aggressive regional goals
• Drive alignment with Pricing, Underwriting, and Sales regarding unit cost and other contracting activities
• Identify strategic opportunities within local market (i.e., network expansion opportunities, utilization or unit cost excesses, etc.)
• Assess market trends and competitive benchmarks to enhance company’s market position
• Support initiatives to improve and maintain highly competitive unit costs across all products to ensure that a superior provider network is available to all employer groups
• Conduct investigations using critical thinking to understand the root cause of problems and propose solutions
• Perform other duties as assigned

Your Knowledge and Experience

• Requires a college degree in business, healthcare policy, public health or related field, or equivalent experience
• Requires at least 10 years provider contracting / negotiation experience including experience managing complex negotiations
• Requires a collaborative team player approach with practical knowledge and proactive leadership and management in the execution of processes and projects within a functional team
• Requires technical and functional expertise, business acumen, critical thinking, and decision-making skills