Recruit and contract Medicare-compliant physicians and ancillary healthcare providers within assigned geographies to build a network ensuring care access for seniors.
Clearly communicate contract terms, payment structures, and reimbursement rates to prospective and existing network providers while maintaining up-to-date documentation in tracking systems.
Build and sustain productive, long-term relationships with provider partners, aligning contracting activities with departmental strategy and organizational objectives.
Lead the development and execution of Clover’s provider network strategy in New Jersey.
Establish and execute on an annual contracting roadmap aligned with affordability, access, and quality goals.
Lead a team to deliver high-quality and data-driven contracting operations.
Clover Health reinvents health insurance by combining data and human empathy to keep members healthier. They have created custom software and analytics to empower their clinical staff to intervene and provide personalized care.
Serves as principal lead on a defined number of providers for negotiation, strategy, and market intelligence.
Assist in the establishment of contract-related criteria and contracting guidelines to optimize financial performance and minimize Plan risk.
Responsible for understanding provider partners’ service needs and incorporating contract solutions to support providers and Capital Blue Cross in reaching shared goals.
Capital Blue Cross aims to go the extra mile for their team and community. Employees consistently vote them one of the “Best Places to Work in PA” due to their supportive colleagues and focus on professional and personal growth.
Negotiate pharmacy agreements across retail, mail, and quality-based channels.
Create and manage network contracting campaigns, analyzing performance metrics.
Work with analytics teams to assess network adequacy and compliance.
Jobgether is a company that uses AI to power the job application process. They ensure applications are reviewed quickly, objectively, and fairly against a role's core requirements.
Develop the provider network through contract negotiations, relationship development, industry analysis and servicing.
Analyze, review, and project financial impacts of network contract arrangements.
Implement reimbursement strategies designed to control healthcare costs.
Blue Cross of Idaho is an Idaho-based health insurance company that has been around since 1945. As a not-for-profit, they are driven to help connect Idahoans to quality and affordable healthcare while building strong networks and services with the help of customer-centric professionals.
Lead the direct negotiation of CareCentrix provider contracts.
Manage the full lifecycle of contract negotiations.
Collaborate with stakeholders to ensure contract terms align with requirements.
CareCentrix manages the provider network. They support contracting activities and oversee network providers across multiple payers; they have an award winning culture and value their employees.
Develop and execute a regional ISNP growth strategy centered on skilled nursing and post-acute partnerships.
Build and strengthen relationships with SNF operators, post-acute leaders, and senior living executives.
Manage the full business development cycle: prospecting, outreach, solution presentations, negotiations, and contract execution.
Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults by providing solutions like on-site primary care and Medicare Advantage Plans. Founded in 2021, they serve 200,000+ seniors in 1,500+ communities across 32 states with a team of more than 1,000 clinicians and professionals.
Serve as the primary partner for Medicare Advantage plans partnering with Ceresti.
Build strong, trusted relationships with plan leadership, population health and care management teams, medical directors, and quality stakeholders.
Own enrollment performance for assigned MA Plan partners, including monitoring referral flow from care management teams.
Ceresti Health built the first national, technology-enabled program that puts family caregivers at the center of dementia care. With nearly a decade of experience working in Medicare Advantage populations, we're at the forefront of transforming dementia care nationwide.
Maintain and deepen senior-level relationships across national and regional payers.
Wheel is evolving the traditional care ecosystem by equipping the nation's most innovative companies with a premier platform to deliver high-quality virtual care at scale. They offer proven strategies and cutting-edge technologies to foster consumer engagement, build brand loyalty, and maximize return on investment.
Own and lead the end-to-end provider strategy for the Northeast market.
Act as the primary voice of the market and provider network, translating on-the-ground insights.
Define, track, and continuously evolve key operational KPIs.
RightMove is redefining how value-based musculoskeletal (MSK) care is delivered in partnership with the Hospital for Special Surgery (HSS). They partner with PCPs, Orthopedic specialists, and health plans to deliver high-value, patient-centered MSK care and are a startup with enterprise-grade rigor.
Coordinate the end-to-end medical provider enrollment process.
Prepare and submit enrollment applications to Medicare, Medicaid, and other payers.
Maintain accurate provider data within internal systems to ensure consistency.
Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults through value-based care. Founded in 2021, it has quickly grown to serve over 200,000 seniors in 1,500+ communities across 32 states with a team of 1,000+ clinicians and other professionals.
Partner with RCM leadership to monitor performance trends and identify revenue cycle opportunities.
Support payer contracting activities, including onboarding clinical network agreements.
Act as program manager for strategic payer partnership initiatives and drive implementation.
Headspace provides access to lifelong mental health support. They combine content, clinical care, and technology to help millions of members around the world get support. Their culture is collaborative, inclusive, and grounded in their values.