Network Contract Manager (MA)

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It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary

The Contract Manager facilitates development; implementation and management of cost-effective provider networks in his/her assigned geographic region(s). Under the direction of the Manager of Physician and Hospital Contracts, the Contract Manager performs all critical functions necessary to assess, develop, maintain and/or improve provider network adequacy and performance.

Our Investment In You

• Full-time remote work
• Competitive salaries
• Excellent benefits
  
  

Key Functions/Responsibilities

• Gathers and analyzes data and other relevant intelligence in assessing provider network adequacy against required standards and business expectations;
• Identifies, assesses and develops strategies for improving provider and network cost, utilization and quality performance;
• Leads negotiations of financial and other contractual terms in all lines of business;
• Ensures all contract terms and conditions comply with financial and legal requirements of WellSense Health Plan and its regulatory entities (e.g., MassHealth, NH DHHS, Commonwealth Connector);
• Develops and maintains business relationships with high-level representatives of key contracting hospitals, physicians and ancillary service providers;
• Participates in the development, implementation & continuous improvement of departmental policies, procedures, workflows, and tools as they relate to network development and provider contracting;
• Performs other duties as required to accomplish departmental and corporate goals & objectives
  
  

Supervision Exercised

• May supervise less experienced staff.
  
  

Supervision Received

• General supervision is received weekly from the Director of Contracting & Provider Engagement.
  
  

Qualifications

Education Required:

• Bachelor’s Degree in Health Care Administration, Business, related field, or an equivalent combination of education, training and experience is required.
  
  

Experience Required

• 3 years of progressive experience in a contracting and analytical capacity is required for individuals with a baccalaureate degree, four years of experience is required for individuals without a baccalaureate degree.
  
  

Required Licensure, Certification Or Conditions Of Employment

• Successful completion of pre-employment background check
  
  

Competencies, Skills, And Attributes

• Proven analytical skill in assessing and projecting financial, utilization and quality performance on an individual provider and network basis;
• In-depth knowledge and understanding of contract finance and provider reimbursement methodologies, including risk, shared savings, pay-for-performance and other financial incentive strategies;
• In-depth knowledge and understanding of current healthcare industry issues and trends, including national and state-level payment reform landscape and strategy (e.g., accountable care and patient centered medical home);
• Proven negotiation skills with hospitals, Integrated Delivery Networks, physicians and ancillary service providers;
• Proven skill in critical thinking and strategic planning and implementation;
• Knowledge of federal and state Medicare, Medicaid, and relevant guidelines, regulations and standards;
• Effective communication (verbal and written) and relationship building skills;
• Expertise in Microsoft Office programs and industry-standard financial applications as appropriate.
  
  

Working Conditions And Physical Effort

• Regular and reliable attendance is an essential function of the position.
• Work is normally performed in a typical home office work environment with occasional travel to provider offices;
• No or very little physical effort required;
• No or very limited exposure to physical risk
  
  

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

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