Contract Manager - Ancillary

Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. 

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

Under the direction of the Point32Health Manager, Allied Health Contracting, the Contract Manager, Allied Health Contracting negotiates and manages contracts with ancillary service providers and network vendors with particularly complex provider and/or reimbursement issues. Key activities include determination of network needs, evaluation of prospective providers, development of reimbursement strategies, and contract negotiation and administration. The Contract Manager must maintain industry-specific knowledge and relationships with key providers and industry groups. This individual serves as a mentor and resource to Associate Contract Managers on the team and may supervise 1-3 Associate Contract Managers.

Job Description

Key Responsibilities/Duties – what you will be doing (top five):

• Develops, negotiates, executes and manages provider contracts for services with complex provider and/or reimbursement issues. Participates in all operational aspects of contractual agreements. Develops and maintains key provider relationships.
• Collaborates with analytic staff to develop medical budget, evaluate cost trends, and formulate reimbursement models and/or program design. Monitors marketplace trends and new reimbursement methodologies.
• Evaluates the demand for assigned services and identifies areas of network deficiencies or increased service demand for network expansion. Determines the unique service capabilities of providers in the network. Designs and implements tools for communicating these capabilities to other departments and membership.
• Identifies, evaluates, and implements new programs for improving medical cost management and/or administrative efficiency.
• Represents Allied Health Services in internal and external meetings. Prepares and delivers presentations to partner departments and industry forums.
• Serves as mentor and resource to Associate Contract Managers on team. May be required to directly supervise 1-3 Associate Contract Managers.
• Other duties and projects as assigned.

Qualifications – what you need to perform the job

Certification and Licensure

Education

• Required: Bachelors degree in a related field
• Preferred: Master’s degree

Experience (minimum years required):

• Required: minimum 5-7 years of professional experience
• Preferred: Experience in a managed health care environment, with a thorough knowledge of the health care market and the needs/concerns of health care providers

Skill Requirements

• Effective communication and presentation skills, both verbally and in writing
• Contract negotiation experience is desirable, with ability to understand and interpret all aspects of a contract: financial, legal, and operational with emphasis on implementation of contract terms
• High degree of initiative and result-orientation, and ability to deal effectively with ambiguous situations
• Proven time management and organizational skills, and ability to work independently and prioritize multiple demands
• Ability to understand the nuances of Tufts Health Plan’s commercial and Medicare Preferred product lines and the unique operational and financial features associated with each
• Ability to lead and motivate others by fostering an attitude of cooperation and commitment, as well as capacity of liaison and negotiator
• Strong financial/analytical skills and problem-solving ability, with the ability to research, interpret, and communicate complex issues
• High degree of professionalism and confidence, including the ability to recognize politically sensitive issues, utilize diplomacy, and interact effectively with all levels of personnel
• Excellent computer skills, including proficiency in Microsoft Word, PowerPoint, and Excel

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

$85,277.30 -$127,915.96

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization.  The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical, dental and vision coverage

• Retirement plans

• Paid time off

• Employer-paid life and disability insurance with additional buy-up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org