This job is responsible for directing negotiation of the plan’s key contracts with health care providers, overseeing financial analyses, and implementing network contract and reimbursement initiatives.
Requirements
- Direct and oversee hospital and institutional provider contract negotiations
- Negotiate rates for nonparticipating provider services
- Manage the design and implementation of provider strategies and reimbursement methodologies
- Develop strategic relationships with key provider constituents
- Engage with external consultants as needed
- Prepare expansion requests for regulatory agencies
- Oversee the production of provider directories and reviews Access & Availability studies
- Facilitate and oversee CACTUS credentialing database functionality