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.
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.
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.
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.
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.