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    Manager Provider Contract Development - Providence, United States - Highmark Health

    Highmark Health
    Highmark Health Providence, United States

    3 weeks ago

    Highmark Health background
    Description
    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

    • 7 years in the Healthcare Industry
    • 7 years in Management
    • 7 years in Contract Development
    • 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 as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

    Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct.

    This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.


    Pay Range Minimum:
    $78,900.00

    Pay Range Maximum:
    $146,000.00

    Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.

    The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

    Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law.

    Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

    EEO is The Law
    Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity (

    )
    We endeavor to make this site accessible to any and all users.

    If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

    For accommodation requests, please contact HR Services Online at
    California Consumer Privacy Act Employees, Contractors, and Applicants Notice

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