Senior Contract Manager

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 Senior Contract Manager is responsible for the development, implementation and management of a cost-effective provider network, maintaining complex and geographically diverse contracts. Under the direction of the Manager of Hospital & Physician Contracting, the Senior Contract Manager assists in the development of network-wide strategies to improve efficiencies and access and 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:

• Interprets environmental (policy, contract, landscape, organizational) changes with contracting and provider impact. Guides internal response strategies.
• 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, including risk sharing terms;
• Ensures all contract terms and conditions comply with financial and legal requirements of WellSense and its regulatory entities (e.g., MassHealth, MA Division of Insurance, EOHHS, etc.);
• 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;
• Represents the department and organization supporting internal and external initiatives;
• May serve as a mentor to less experienced Contract Managers
• 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 Manager of Hospital & Physician Contracting.

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: __

· At least 5 years of experience in a contracting and analytical capacity is required for individuals with a baccalaureate degree, 7 years of experience is required for individuals without a baccalaureate degree.

Experience Preferred/Desirable:

· Medicaid managed care experience preferred

Required Licensure, Certification or Conditions of Employment:

· Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

• Interpersonal and leadership style necessary to serve as ‘go-to’ resource for colleagues;
• 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. Position will interact with internal and external executive teams;
• Expertise in Microsoft Office programs and industry-standard financial applications as appropriate.

Working Conditions and Physical Effort:

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

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

Required Skills

Required Experience