Director of Provider Relations & Contracting
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. Director of Provider Relations & Contracting Position DescriptionThis position is responsible to secure and maintain competitive contractual relationships with providers in accordance with regulatory, operational and financial goals and standards. Lead efforts to engage providers in strategic and innovative partnerships. Provide leadership and direction to local network management team to ensure UCare's adherence with network oversight goals and regulatory requirements. Provide insight into provider market changes and opportunities to internal committees and stakeholders. Specific duties and responsibilities include: Coach, mentor, and manage a high-performing team of professionals to achieve favorable and timely contract terms, build and strengthen relationships with key providers, and support UCare's strategic provider-related goals.Lead the development of provider network and contracting strategy. Bring provider market intelligence and insights to key internal provider forums to inform direction and decisions.Develop an annual negotiation plan in collaboration with teams and other internal stakeholders. Report status quarterly to department leadership and key committees.Develop care system contract tracking as a tool to collaborate with PO&A, PEC and HCE on planning and operationalizing contracts.Develop and maintain network oversight plans by provider/network type. Ensure contractual, regulatory and NCQA compliance for network providers.Support program management efforts related to unique Medicare and Medicaid networks. Ensure departmental staff members align work efforts with enterprise-wide goals and objectives for these networks/services.Develop and achieve department goals and strategies in collaboration with VP, PRC.Serve as the first point of contact for escalated provider contract issues. Work with staff to find resolution where possible and keep leadership informed. Escalate critical issues as appropriate to leadership and other key stakeholders (e.g., legal, compliance, SIU, clinical services, etc.).Collaborate with team members to establish regular meetings with key UCare care systems to explore strategic, operational, clinical, quality, and financial opportunities. Collaborate with internal departments to bring an interdisciplinary team approach to meetings, building and sharing data/reports, and preparing other key meeting materials.Participate on assigned UCare committees and work groups to represent departmental interests. Regularly engage department staff as needed to meet committee objectives and report to department leadership and staff as appropriate.Interact with other departments on a regular basis to discuss and resolve problems, assist in interpretation of policies and procedures, and promote effective communication between UCare and individual providers and their staff.Support strategic and operational efforts as needed.Other projects and duties as assigned. EducationBachelor's Degree in health care management or related field; demonstrated experience may be considered in lieu of degree. Master's degree preferred.Required ExperienceTen or more years of Network Management/Contract negotiation. Six or more years of Network Management/Provider relations. Eight or more years of Network/Provider contract management. Four or more years of Network strategy. Demonstrated ability to successfully work in matrixed/cross-departmental environments. Demonstrated staff supervisory/management experience.Preferred ExperiencePrevious involvement with Medicare, Medicaid, and commercial insurance products/programs, either from the provider or payer perspective. Experience developing reimbursement strategies and an understanding of the relationship of provider reimbursement to health care costs. 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.