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UCare

Provider Contracting Principal

This job has now expired

Employer
UCare
Posted
Wednesday, June 27, 2012
Closes
Wednesday, July 04, 2012
Category
Employment Status

Further information

Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota’s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We’re an organization that’s going places. Be part of a team that cares about you, be part of UCare.

The Provider Contracting Principal will develop, implement, and retain care system, institutional, primary care, specialty care, and ancillary provider networks to include: contracting, expansion efforts, special initiatives and building and maintaining strong provider relationships. Specific duties and responsibilities include:



  • Coordinate the contracting process with care system, institutional, primary, specialty, and ancillary providers, including contract completion and documentation to enable contractual terms are implemented in the system timely and accurately. Work closely with Assistant Director – Provider Contracting to coordinate contracting for other provider types.
  • Coordinate regularly scheduled meetings with contracted providers to provide timely communication, effective education and enhanced provider relationships. Effectively problem solve issues, and transfer issues to Coordinators as appropriate, including but not limited to the following: global claim issues, provider configurations, authorizations, care management and enrollment assignments.
  • Develop and maintain provider networks to ensure adequate coverage for all products. 
  • Monitor new and existing provider networks for network adequacy and expansion opportunities, and develop action plans for addressing deficiencies. Initiate and orchestrate provider recruitment, contracting, and related development efforts.   
  • Collaborate with Provider Enrollment and Configuration (PEC) to resolve contractual issues and articulate the detail needed to load contracts into UCare’s system in a timely and effective manner. 
  • Monitor providers for compliance of state, federal and other regulatory agency requirements. Initiate actions against providers that are not in compliance.
  • Guide and facilitate regular communication with other UCare departments including, Government Relations, Health Care Management, Quality Improvement, Finance, Claims, Marketing, and Product Development. Provide internal support for timely resolution of provider related issues. Act as a liaison and participate in relevant interdepartmental committees and workgroups. 
  • Recommend, develop and propose administrative procedures and policies that enhance relationships with providers, enrollees and other UCare customers as needed.
  • Assist in compiling monthly, quarterly, and annual departmental metrics and attainment of individual annual goals and department goals. Develop and maintain new methods of documenting activities.

This position requires five to seven years in a health delivery setting, such as physician group practice, health insurance, HMO, or community service agency including experience in an administrative/managerial role. Three to five years contracting experience required. Three to five years of supervisory experience required. Understanding of Medicare and Medicaid. Knowledge of local provider systems is strongly preferred. A Bachelor’s degree in health care management, finance, or related field desired. Relevant experience will be considered in lieu of degree.  A Master’s degree is preferred.


 


Knowledge, Skills, and Abilities required for this role include:



  • Excellent oral and written communication skills.
  • Proven interpersonal communication skills.
  • Proven ability to collaborate with other departments.
  • Excellent organizational skills.
  • Strong supervisory/leadership skills.
  • Demonstrated negotiation/conflict resolution skills.
  • Strong problem solving skills.
  • Strong analytical skills.
  • Ability to manage multiple priorities.

Rewards

Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You’ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis—just minutes from major freeways and retail centers. At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
www.ucare.org/careers/
EOE/AA

UCare

You can also apply at jobs@ucare.org Star Tribune 2012 Top Workplace. UCare provides more than 285,000 health plan members with the health coverage plans and services they need to maintain and improve their health.