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Manager, Health Plan Relations and Contracting

Summary

This position will oversee the health plan contracting and maintenance, as well as, health plan relations for MPM.  It will interface with all internal departments and clients to ensure the terms of the health plan and riskpool contracts are properly interpreted and implemented.  It will interact with the different health plans to address operational items and issues.

This position will lead, or participate as a significant team member, in both the language and financial negotiations with health plans and hospitals for all product lines. Contract review, analysis, strategic planning and preparation for contract negotiations, will be managed by this position. A thorough understanding of health plan and riskpool contract terms, the different product lines, DOFR interpretation, IPA and hospital operations related to the implementation of health plan and riskpool contract terms, as well as, MSO operations is a requirement.

Duties and Responsibilities

  • Develop and maintain existing systems to maintain health plan and risksharing agreements to track contract terms and ensure timely renewals/renegotiations.
  • Interface with all applicable MPM internal departments and clients to ensure proper implementation of contract terms.
  • Develop strategies to improve revenue to clients and improve other terms in health plan and riskpool contracts.
  • Conduct and manage the analysis and review of health plan and risksharing contracts and their financial terms to prepare for contract negotiations.
  • Lead, or assist in, contract negotiations with health plans and hospitals (risksharing agreements).
  • Manage relationships with all health plans on behalf of MPM and its IPA clients. Maintain positive professional relationships with health plan representatives at all times.

Minimum Job Requirements

  • Bachelor’s Degree – Preferably in Business Administration, Healthcare Administration, Finance, Accounting, or equivalent combination of education and/or work experience.
  • 8 years of related healthcare experience in contract negotiations.
  • In-depth understanding of DHMC, DHCS, CMS and other regulatory requirements and guidelines related to IPA and Hospital contracting and operations.
  • Advanced project management skills.
  • Outstanding leadership, management and organizational skills.

Preferred Job Requirements

  • Master’s Degree – Preferably in Business Administration, Healthcare Administration, Finance, Accounting
  • Hospital, IPA and/or MSO experience

Knowledge, Skills and Abilities Required:

  • Excellent oral and written communication skills
  • Excellent analytical and strategy development skills
  • Knowledge of Microsoft Office Suite, including but not limiting to Excel and Word
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