Non IT Project Manager

Location : CHICAGO, IL (onsite)

Duration: 12 Months

Primary Skill Required for the Role : Healthcare Provider Performance Assessment & Improvement

Job Description Provider Network Contractor

The provider network contracting role involves managing the creation, negotiation, and maintenance of contracts between a payer and each of its network providers. Key responsibilities include negotiating contract terms and rates, building and maintaining relationships with providers, and ensuring the network is adequate, cost-effective, and compliant with regulations. This role requires strong negotiation, analytical, and communication skills to balance network adequacy, access and quality with financial performance.

Core Responsibilities

Contract negotiation:

Negotiate and execute contracts with a variety of providers, including physicians, hospitals, and ancillary services, ensuring the terms are high-quality and cost-effective.

Network development:

Recruit and develop provider networks to meet the healthcare organization's membership needs, including identifying new providers and executing agreements.

Relationship management:

Serve as a liaison between the organization and providers, building and maintaining strong relationships, and resolving issues.

Performance and compliance:

Monitor and evaluate the performance of providers and contracts, analyze network adequacy, and ensure compliance with all relevant regulations.

Financial analysis:

Analyze rate scenarios, develop financial projections, and provide input for rate-setting strategies to ensure the network's financial health.

Provider education:

Orient and train providers on the organization's operations, policies, and new programs.

Education:

A bachelor's degree, in a health-related field, business, or public administration.

Experience:

Experience in managed care, provider relations, or contract management is highly desirable.

Skills:

1. Strong negotiation and communication skills

2. Analytical and problem-solving skills

3. Knowledge of healthcare reimbursement methodologies and contractual language

4. Proficiency in Microsoft Office Suite and other relevant applications

5. Ability to manage multiple projects and work independently or collaboratively