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Resp & Qualifications
PURPOSE:
We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. This position is responsible for contracting and recruiting network providers. Responsibilities include strategic project planning, the negotiation of network participation agreements with health systems and significant/key providers, oversight of staff and the development of CareFirst networks.
ESSENTIAL FUNCTIONS:
CONTRACTING:
Evaluate the geographic, financial and network access impacts of individual provider agreements.
Prepare negotiation strategies for managements review and approval.
Responsible for more complex contracts and negotiations.
Compare network access of CareFirst to commercial competitors.
Determine alternate access for similar provider types and compare quality of care measures.
Quantify appropriate financial terms commensurate with negotiation leverage.
Draft most-favored-nation clauses to minimize care costs and ensure a competitive advantage.
Negotiate all network contract terms with providers.
Prepare all proposals, analyses and non-standard contract amendments.
Coordinate with the payment transformation to develop value based arrangements when applicable.
Confirm network participation with all rate rate requests and recruit into networks as applicable.
NETWORK MANAGEMENT AND DEVELOPMENT:
Track and analyze provider-specific requests in a timely manner.
Recruit providers in support of corporate projects, and in support of existing and prospective CareFirst accounts.
Develop all networks to obtain and/or maintain a competitive advantage for all specialties throughout the entire CareFirst service area.
Dissuade providers from terminating their participation agreements.
SUPERVISION AND STRATEGIC PROJECT PLANNING:
Contribute to the planning of strategic objectives/projects for the department.
Provide supervision of staff for negotiation strategies and day-to-day activities.
Coordinate department activities to meet Corporate Project deliverables.
Provide oversight to the implementation process of non-standard contracts with Provider Reimbursement and Provider Information & Credentialing.
Assists Manager with direction and vision for policy and quality standards for all departmental work; inventory trends and impacts; associate actions plans; tactical planning, implementation, monitoring and reporting.
ANALYSIS AND MAINTENANCE:
Manage non-standard contract provisions and future changes.
Monitor healthcare industry changes and trends.
Recommend providers for termination as appropriate.
Identify opportunities for performance improvement and financial savings.
CONTRACT MANAGEMENT:
Assure contracts comply with all regulatory and statutory mandates, corporate policies and BlueCross BlueShield Association requirements.
Draft and mail amendments to comply with jurisdictional changes.
Work with the Legal and Corporate Communications departments to develop appropriate responses to contract issues.
Ensure that all contracts are uploaded into Contract Management system, as appropriate.
PROVIDER FOCUS:
Build and maintain positive provider relationships.
Act as a CareFirst liaison with providers and facilitate effective communication.
Participate with interdepartmental teams to improve provider service and satisfaction levels.
SUPERVISORY RESPONSIBILITY:
This position manages people.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Business, health care administration or related field OR In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 3 years experience with progressively increasing responsibility in provider recruitment and/or provider relations. Demonstrated leadership.
Preferred Qualifications
Knowledge, Skills and Abilities (KSAs)
Strong interpersonal skills. Ability to work independently, as well as a member of a team.
Strong critical reasoning skills in clinical decision-making, planning and organizing.
Current knowledge of clinical practices and related information systems and computer applications.
Knowledge of professional knowledge and skills related to pharmacy practice.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $79,776 - $164,538
Salary Range Disclaimer
Salary will be based on education, location, experience, certifications, etc. In addition to your salary, CareFirst offers benefits such as a comprehensive benefits package, incentive and recognition programs, and 401k contribution (all benefits are subject to eligibility requirements).
Department
Department: Professional Contracting, Recr
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
#LI-NH2
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