Provider Contracting Executive SR
Remote only within (ID, OR, UT, WA)
The Provider Contracting Executive Senior is responsible for contracting relationships with physicians, physician groups, institutions and ancillary providers including the development of contracting strategies, coordination of analytical support, negotiation, and effective administration. They cultivate and maintain relationships with key providers and promote innovative products and reimbursement methodologies.
The Provider Contracting Executive Senior is responsible for the largest and most complex contracting relationships.
- Maintains and expands the health care delivery system network by negotiating contracts and maintaining relationships with providers.
- Cultivates relationships with providers that position the organization to meet its objectives relating to cost effectiveness, quality of care, enrollment growth, administrative efficiency, product positioning and profitability.
- Monitors financial and utilization performance of contracts and develops plans to improve performance with the Health Care Services division.
- Regularly meets with key provider leaders to review cost/utilization reports, prepares analysis, recommends strategies, researches problem issues and serves as the primary "client manager."
- Develops and maintains new regional networks to support the introduction of new products, maintaining a high understanding of the health plan market pricing and communicates the strategic benefits to providers of participating in new networks and products.
- Works collaboratively with the provider consultants and representatives to ensure that contracts are appropriately administered and that improvement plans are being managed.
- Supports specific initiatives (based on potential cost savings and the impact on member care and providers) which will reduce our healthcare expenditures while still delivering the best care possible to our members.
- Develops and manages risk arrangements including developing, arranging and maintaining pricing and accountable health system funding arrangements.
- Develops long and short range contracting strategies for each delivery system assigned.
- Develops contracting strategy and manages the largest and most complex relationships with accountable care organizations, health systems, hospitals and physician groups.
- Leads Plan initiatives and/or pilots focused on strategies directed at Provider Network configuration, reimbursement and management that will reduce health care cost while ensuring continued high quality care is delivered to our members.
- Serves as a mentor to new contractors and others within the department and resources within the company.
Normally to be proficient in the competencies listed above
- Strong understanding of managed care and accountable health system models and relationship to contracting strategy and reimbursement methodology.
- Proven ability to build positive relationships and negotiate successfully with institutional, professional, and ancillary providers.
- Demonstrated competency related to varying payment methodologies and value base contracting. (such as Pay for Quality/Performance, DRG, APC, ASC, Capitation, Fee for Service, RBRVS, Per Diem, Per Case)
- Ability to analyze financial, quality, and utilization data and use to develop contracting strategies. Ability to organize and manage a portfolio of contracts.
- Ability to work in high-pressure circumstances and effectively manage conflict and ambiguity. Senior Provider Contracting (requirements in addition to above)
- Proficiency building relationships and negotiating successfully with large and complex market-leading institutional and professional providers.
- Ability to independently and effectively communicate with high level executives internally and externally.
The Provider Contracting Executive Senior would have a Bachelor'
s Degree in healthcare, business or a related field and 7 years'
experience in a healthcare industry provider contracting, relations or analytical capacity or equivalent combination of education and experience.
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.
If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.
This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check are required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com