Details: Position Purpose: To coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi-specialty groups) and ancillary service agreements that are in accordance with Corporate, health plan and State guidelines. Position Responsibilities: • Recruit and develop a provider network plan for region and set of providers. I • Identify and initiate contact with potential providers. • Negotiate contracts. • Leads assigned negotiations (i.e., hospital, physician and ancillary) and ensure that the negotiations result in the unit cost targets expected and meet the objectives of the Company and approximate the State’s reimbursement to the provider. • Facilitate and provide oversight to the provider set-up and contract configuration to ensure accurate claims adjudication. • Evaluate and monitor providers’ performance standards and financial performance of contracts. • Assist with and track credentialing activities. • Facilitate the organization of provider focus groups. • Coordinate with internal departments and contracted providers to implement and maintain contract compliance.
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