Provider Contracting Principal
7 days left
- Employment Status
- Full Time
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.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities. WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. PROVIDER CONTRACTING PRINCIPAL Position DescriptionThis position is responsible to develop, implement and maintain care system, institutional, primary care and ancillary networks; including contracting, expansion efforts, special initiatives and building and preserving strong provider relationships. Specific duties and responsibilities include: Coordinate the contracting process with care system, institutional, primary care, and ancillary providers, including contract completion and documentation to ensure contractual terms are implemented in the system timely and accurately. 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. Negotiate contracts with key partners to provide initiatives specific to key quality (i.e. HEDIS/STAR/NCQA) ratings for improvement in specified measures.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 staff from 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 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. EducationBachelor's degree in health care management, finance; demonstrated experience may be considered in lieu of degree. Master's degree preferred.Required ExperienceOne year experience in a health delivery setting, such as a physician group practice, health insurance, HMO or community service agency. Excellent verbal and communication skills, including the ability to listen effectively, persuasive negotiation skills, and the ability to communicate both strategic and technical issues to individuals and in presentations to groups.Preferred ExperienceACO/population management experience. Knowledge of local provider systems. Knowledge of state and federal health care programs. Software knowledge (Excel). THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 8th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
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.