UCare

Provider Contracting Principal

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Apr 21, 2018
Closes
Apr 25, 2018
Category
Healthcare
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 UCARE

At 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 UCARE

Working 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 Description

This position is responsible for developing, implementing, and managing contracting activities for care systems, institutional, primary care, and ancillary providers. This includes, but is not limited to the development and execution of negotiation strategies, expansion efforts, special initiatives and building and preserving strong provider relationships. Specific duties and responsibilities include:   

Lead the negotiation of contracts for care systems and key provider partners. This may include the integration of value-based initiatives specific to quality ratings for improvement of specified measures.

Ensure that contracts and payment terms are negotiated in accordance with established contract administration policies and procedures, including state, federal, and other regulatory requirements.

Develop and maintain strong working relationships with assigned providers and manages all aspects of the provider relationship. This may include coordinating regularly scheduled meetings with contracted providers to promote effective communication, effective education, and enhance provider relationships.  

Analyze complex data in conjunction with Health Care Economics department to interpret contracting and financial data for provider negotiations and other initiatives.

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.

Possess extensive in-depth knowledge of reimbursement methodologies, contract compliance issues, claims processing operations, medical management practices, and quality standards and clinical initiatives that impact provider performance.

Recommend, develop and propose administrative procedures and policies that enhance relationships with providers, enrollees, and other UCare customers as needed.

Participate in internal workgroups as required by leadership. Mobilize and utilize corporate resources to achieve objectives of the department.

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.

Other projects and duties as assigned. 

Education

Bachelor's degree (B.A. or B.S.). Demonstrated experience may be considered in lieu of degree.

Required Experience

Four years of related experience in provider contracting or payer relations. Working knowledge in the areas of Risk or Value based contracting.

Preferred Experience

ACO/population management experience.  Knowledge of local provider systems. Knowledge of state and federal health care programs.  Software knowledge (Excel).

 

THE UCARE DIFFERENCE

UCare 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.

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

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