Manager, Provider Relations & Contracting

Company: Fidelis Care - New Jersey
Location: Iselin
Posted on: November 18, 2024

Job Description:

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

Candidate MUST live in New Jersey

Position Purpose: Implement development activities for the recruitment, contracting and retention of behavioral health providers. Negotiate contracts and develop strategies and methodologies for specific network development initiatives.

• Monitor business processes related to provider contracting to determine their efficiency and protective value, and assure integrity of records, information and systems in compliance with Company policies/standards and government regulations.
• Prepare provider contracts and monitor process to ensure timely execution of contracts.
• Manage fee schedules, ensuring timely and accurate loading in company IS system.
• Monitor and oversee provider contract compliance and issue corrective action letters for non -compliance.
• Conduct and oversee administrative audits of provider agencies.
• Prepare and analyze reports and records on functional area and on organizational activities, recommend improvements for upper management.
• Monitor operational and financial performance of agreements using results to guide future negotiations.
• Meet individually with providers to develop long-term relationships and resolve operational issues.
• Review redline contract language and provide accept/decline recommendations to management.
• Ability to travel as needed to provider meetings.
  Education/Experience: Bachelor's degree in related field or equivalent experience. Master's degree preferred. 5+ years of contracting, network development and/or provider relations experience. Project management experience. Experience in a healthcare or insurance environment, preferably in Medicaid. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. Experinece within Behavioral Health preferred
  Pay Range: $84,300.00 - $151,700.00 per year
  Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
  
  Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
  
  Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Keywords: Fidelis Care - New Jersey, Levittown , Manager, Provider Relations & Contracting, Executive , Iselin, New York