Source Job

• Assist with planning, directing, and implementing managed care objectives related to contract terms, reimbursement, negotiation, and key payer relationship management.
• Negotiate various contract types across the organization's geographies and business lines with significant payer relationships.
• Secure favorable reimbursement, protect the interests of associated entities in contract negotiations, and strengthen relationships with significant payers.

CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings.

• Manage key relationships and ensure efficient revenue cycle operations.
• Drive strategic initiatives to streamline interactions with payors.
• Maximize revenue and foster a culture of excellence, enhancing patient experiences.

Jobgether is a company that uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. The system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company.

• Own end-to-end contract lifecycle for extensive contract portfolio.
• Partner directly with practices to ensure successful contract onboarding and ongoing compliance.
• Act as the SME of the Explorer market with all relevant groups such as Payer Networks, SPP, Withdrawal, Legal, and Growth teams.

Aledade, a public benefit corporation, empowers independent primary care. Founded in 2014, they've become the largest network of independent primary care in the country, helping practices deliver better care and thrive in value-based care with a collaborative, inclusive, and remote-first culture.

• Serves as procurement resource for assigned categories and/or departments through collaboration with business unit leaders.
• Leads the negotiation of the financials, contract length, and deliverable / product / service terms of supplier contracts.
• Develops and analyzes key reporting metrics designed to track overall efficiency of the process and internal spend data for assigned categories.

EMC strives to be caring leaders, close partners, and responsive experts, always supporting each other to do their best work. They have more than 105 years of financial strength and stability and a corporate culture that engages and empowers team members.

• Lead the development, optimization, and performance of Clover’s dental provider network.
• Build Clover’s dental network strategy from the ground up across markets.
• Build, scale, and lead a high-impact dental network team spanning contracting, analytics, and provider relationship management.

Clover Health is committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors. The company prioritizes preventive care while leveraging data and technology; they are passionate and mission-driven individuals with diverse areas of expertise.

• Strategically analyze agreement opportunities and lead communication efforts to negotiate agreements with external stakeholders/suppliers.
• Foster and cultivate strong working relationships with department and business unit leadership.
• Collaborate closely with business unit leadership to develop comprehensive RFP and non-RFP project plans.

Allied Solutions provides services for HR, Finance, Legal, Marketing, Facilities, Bond, Product Management and Sales Enablement Operations. The company is committed to career growth opportunities and has been recognized by Forbes as one of America's Best Midsize Employers.

• Lead the Market Access Contracting team, providing development, direction, and oversight on a daily basis.
• Review, approve, and sign Market Access Contracts; ensure department is SOX compliant and serve as contracting lead for periodic internal and external audits.
• Lead the Pricing Governance Process for assigned Accounts and Segments, coordinating across the cross functional partners in Market Access, Legal, MMF, Finance, and Trade Ops.

Novartis focuses on the needs of people and a community committed to meeting them to improve the lives of people living with disease. It is a team working, learning and thriving together.

• Own market operational performance against organizational and contractual outcomes, ensuring initiatives drive measurable clinical and financial results
• Lead operation partnerships with customers in the market, aligning on market strategy, contractual goals, and performance targets across cost, quality, and member experience.
• Partner with the clinical leadership to align care model execution with operational strategy, ensuring seamless member experience and optimized performance outcomes

Tuesday Health is a value-based palliative care provider group dedicated to transforming serious illness and end-of-life care. Through our leading-edge care model, Tuesday Health is shaping the future of community-based palliative care nationwide.

• Responsible for establishing an infrastructure to support negotiations, implementation and oversight with all contracted vendors.
• Develop metrics reporting from all vendors and have strong analytical skills to evaluate effectiveness of programs.
• Serve as liaison between vendors and claims staff; audit, measure, report and evaluate all vendor’s performance.

Crum & Forster (C&F) provides specialty and standard commercial lines insurance products. They have over 2000 employees and are known for their employee-first focus and commitment to diversity, equity, and inclusion.

• Processes acute and post-acute inpatient medical and select intensive outpatient higher level of care requests through clinical review.
• Interprets and applies InterQual criteria, CMS-issued guidelines, Capital Blue Cross Medical Policies to requests.
• Collaborates with UM department staff and Medical Directors to make a final determination, and with Care Management staff on discharge planning.

Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. At Capital, employees work alongside a caring team of supportive colleagues and are encouraged to volunteer in their community.

• Manage multiple channel interactions professionally and efficiently.
• Effectively present products/services to providers with integrity, understanding, and accuracy.
• Focus on provider retention through first call resolution and maintain positive relationships.

Capital Blue Cross promises to go the extra mile for its team and community. Employees consistently vote it one of the “Best Places to Work in PA”, valuing professional/personal growth by investing heavily in training and continuing education.

• Responsible for coordination of services for members, emphasizing education/self-management and quality care. \n- Assesses member needs, reviews service options, develops and implements care plans, and coordinates resources. \n- Manages a caseload of moderate-high risk members with complex medical/behavioral/psychosocial needs.

Capital Blue Cross is committed to improving the health and well-being of our members and the communities in which they live. They offer flexibility, prioritize health and well-being, and encourage employees to volunteer in their community.

• Own our payer contracting strategy, aligning business interests with legal terms and regulations
• Build for scale and implement systems to land high-value payer contracts efficiently
• Review and negotiate the terms of Headway’s health plan agreements

Headway's mission is to build a new mental healthcare system everyone can access. They have grown into a diverse, national network of over 60,000 mental healthcare providers across all 50 states and have served over 1 million patients.