Provider Contract Manager
Posted on: January 20, 2023
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PacificSource is an equal opportunity employer. All qualified
applicants will receive consideration for employment without regard
to status as a protected veteran or a qualified individual with a
disability, or other protected status, such as race, religion,
color, national origin, sex, sexual orientation, gender identity or
age. Diversity and Inclusion: PacificSource values the diversity of
the people we hire and serve. We are committed to creating a
diverse environment and fostering a workplace in which individual
differences are appreciated, respected and responded to in ways
that fully develop and utilize each person's talents and strengths.
Position Overview: Accountable to lead, develop, and maintain
strong, positive relationships with assigned standard and complex
provider accounts, including assurance of provider satisfaction
with PacificSource. Proactively manage assigned provider accounts
to achieve PacificSource's strategies and goals for product and
provider contract development Essential Responsibilities:
- Develop and maintain effective provider networks and monitor
the adequacy of those networks under the guidance of the Contract
- Accountable for network contracting results for assigned
markets or provider entities and efficiently manage resources to
achieve department goals and initiatives.
- Lead negotiation and implementation of provider contracts for
assigned markets or provider entities and act as the main point of
contact for assigned accounts with respect to negotiations and
- Proactively communicate with PacificSource management on
account status to facilitate proper internal support of account
- Develop and implement contracting strategies which meet
corporate financial objectives; working within the budgetary
- Complete negotiations within preplanned rate targets, meet
timelines, ensure implementation period is timely and takes
responsibility for accurate implementation of the contract is
- Demonstrate advanced knowledge of varying payment methodologies
including but not limited to DRG, Capitation, Fee-for-Service,
RBRVS, Per Diem, Per Case, and Percent of Charges.
- Exercise independent judgment and communicate effectively with
other members of the Provider Network Department and other related
- Communicate regularly with internal staff, departments, and
district offices the status of contract negotiations and potential
impact on operations throughout the negotiation process and obtain
feedback as appropriate to ensure the final contract supports the
PacificSource operational and strategic goals.
- Partner with other Provider Network staff to ensure
PacificSource strategies are being met with the provider
- Build and maintain positive provider relationships that foster
a collaborative approach to quality care, network stability and
- Accountable for the relationship management for assigned
provider accounts which includes the multi-disciplinary
PacificSource team to provide operationally excellent service and
support to the accounts.
- Participate in provider specific and public presentations as
- Participate in special projects related to PacificSource
initiatives and other duties as assigned.
- Demonstrate knowledge and support of PacificSource corporate
- Proactively develop positive working relationships with other
PacificSource departments and staff to resolve provider issues.
- Meet department and company performance and attendance
regulations concerning confidentiality and security of protected
- Perform other duties as assigned. Work Experience : Minimum of
4 years' experience in provider contracting; experience can be
within the health insurance industry, provider organization, or
related field in provider reimbursement. Experience should include
the proven ability to negotiate, manage provider relationships, and
demonstrate the ability to execute strategy. Education,
Certificates, Licenses: BA or BS in business, health care
administration, finance, or equivalent combination of education and
experience required. Knowledge: Excellent public relations and
interpersonal skills. Excellent written and verbal communication
skills. Strong analytical skills. Ability to draft contract
language to meet legal criteria and familiarity with provisions in
health insurance. Excellent presentation skills. Understanding of
complex financial arrangements and quality programs across health
care products. Knowledge of different forms of reimbursement
including capitation and their ramifications on providers as well
as insurers. Strong data management skills. Demonstrated knowledge
of regulatory issues and network development. Strong experience and
expertise in the provider environment. Ability to gain a thorough
understanding of PacificSource products. Knowledge of provider
profiling software, systems, and provider data utilization.
Self-starter and the ability to lead with minimal direction. Proven
ability to lead and mentor small teams. Strong organizational,
planning and administrative skills. Current driver's license and
the ability to travel. Competencies
- Building Customer Loyalty
- Building Strategic Work Relationships
- Building Trust
- Continuous Improvement
- Contributing to Team Success
- Planning and Organizing
- Work Standards Environment: Work inside in a general office
setting with ergonomically configured equipment. Travel is required
approximately 15% of the time. Our Values We live and breathe our
values. In fact, our culture is driven by these seven core values
which guide us in how we do business:
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to
foster individual, team and company growth.
- We actively participate in efforts to improve our many
communities-internally and externally.
- We actively work to advance social justice, equity, diversity
and inclusion in our workplace, the healthcare system and
- We encourage creativity, innovation, and the pursuit of
excellence. Physical Requirements: Stoop and bend. Sit and/or stand
for extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing. Light
lifting and carrying of files and business materials. Ability to
read and comprehend both written and spoken English. Communicate
clearly and effectively. Disclaimer: This indicates the general
nature and level of work performed by employees within this
position and is subject to change. It is not designed to contain or
be interpreted as a comprehensive list of all duties,
responsibilities, and qualifications required of employees assigned
to this position. Employment remains AT-WILL at all times. This
employer is a corporate member of
myGwork - LGBTQ+ professionals, the business community for LGBTQ+
students, inclusive employers & anyone who believes in workplace
Keywords: myGwork, Bend , Provider Contract Manager, Executive , Bend, Oregon
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