Job Details
Conducts outreach to potential providers. Supports development of the provider network (physicians, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for cost performance Performs straightforward contract negotiation and pricing - evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties Balance financial and operational impact of contracts to providers, members, and different customer groups when developing and/or negotiating contract terms Support evaluation of market rates and provider performance (e.g., billing patterns; referral patterns; quality and effectiveness) in order to establish provid...Network, Manager, Contract, Contracts, Remote, Health, Technology, Healthcare