- Manage complex contracting and negotiations for fees for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups)
- Build relationships that nurture partnerships and seek broader value-based business opportunities to support the local market strategy
- Initiate and maintain effective channels of communication with internal partners including but not limited to, billing and payment operations, Care Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service
- Manage strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements
- Contribute to the development of alternative network initiatives; Supports and provides direction to develop network analytics required for the network solution
- Work to meet contracting targets (adequacy, accessibility, medical cost spend, etc.), while preserving an adequate network, to achieve and maintain Company's competitive position
- Prepare, analyze, review, and project financial impact of larger or complex provider contracts and assesses alternate contract terms
- Manage key provider relationships and is accountable for critical interface with providers and business staff
- Demonstrate knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape
- Track current contract performance and process renegotiations and changes, amendments, and extensions to existing agreements
- Review and revise provider contracts as necessary to reflect updates in business strategy or organizational developments