Manager-Provider Relations Job Code: 22242 FLSA Status Job Family: ADMIN SUPPORT Job Summary Identifies, evaluates and negotiates contracting opportunities to grow the existing business, develop new business and expand p…
Skills: Managed care contracting, Contract negotiation, Reimbursement methodologies, Health benefit plan design, Contract management
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Full-time
bachelor degree, postgraduate degree
Posted 96d ago
~40 hrs/week
Responsibilities
The manager identifies, evaluates, and negotiates contracting opportunities with various payors and providers to expand the network and grow business. They also oversee contract department operations, ensure legal compliance, and manage the renewal process for existing payor contracts.
Requirements
Candidates must have at least 3 years of experience in health care contracting, reimbursement, and benefit plan design. A bachelor's degree in health care or business administration is required, with a master's degree preferred.
Full job description
Manager-Provider Relations
Job Code: 22242
FLSA Status
Job Family: ADMIN SUPPORT
Job Summary
Identifies, evaluates and negotiates contracting opportunities to grow the existing business, develop new business and expand provider network. In-depth understanding of health care and managed care contracting concepts, reimbursement, methodologies, and health benefit plan designs. Perceptive of general market conditions and the managed care market both provider and payor. Ensures application of appropriate business and legal protocol for contracting services to comply with organization and departmental missions. Serves as liaison for contract communication with other organizational representatives. Manages contract department, support staff, contract document control, and renewal process for payor contracts.
Job Responsibilities
Identifies and evaluates managed care contracting opportunities to grow the existing business, develop new business with various third party payors, including but not limited to insurance carriers, third-party administrators, managed care networks, self-funded payors, business alliances and provider organizations and to expand the provider network. Analyzes contract opportunities utilizing contract guidelines in order to improve organization's market share.
Negotiates contracts with various providers and third party payors. Manages the necessary interface to bring these negotiated contracts to closure and inform senior management of contract activity.
Maintains proficient knowledge of managed care contracting concepts, including but not limited to reimbursement methodologies, e.g., capitation, per diems, DRGs, case rates, and discounted fee-for-service; and, health benefit plan designs, including PPO, POS, EPO and HMO. Extrapolates information from payor's health benefit plans and health care reimbursement arrangements to complete contract summaries, contract information loadsheets and other reports as required to meet organizational obligations.
Maintains current knowledge of managed care market and market trends, both provider and payor.
Ensures that appropriate business and legal protocol are applied for contracting services to ensure compliance with organization and departmental missions; consults with legal on contracting issues.
Serves as liaison for contract communication with other organizational representatives; manages document control of contract file.
Manages renewal process for payor contracts, including renegotiation. Analyzes utilization data submitted for contract renewal by following contracting guidelines to monitor contract performance.
Performs other duties as assigned.
Specifications
Experience
Description
Minimum Required: 3 years experience with health care contracting with health care reimbursement and health benefit plan experience.
Preferred/Desired
Education
Description
Minimum Required: Bachelors degree in health care administration or business administration.
Preferred/Desired: Masters degree in health care administration or related field
Training
Description
Minimum Required
Preferred/Desired
Special Skills
Description
Minimum Required: Effective in making effective presentations to various provider and payor groups; strong analytical, negotiation, leadership, marketing, and verbal/written communication skills.
Baptist Memorial Health Care is one of the country’s largest not-for-profit health care systems and the largest provider of Medicaid in the region. Baptist offers a full continuum of care to communities throughout the Mid-South and consistently ranks among the top integrated health care networks in the country. The health care system comprises 24 affiliate hospitals in West Tennessee, Mississippi and East Arkansas; more than 5,400 affiliated physicians; Baptist Medical Group, a multispecialty physician group with more than 900 providers; home, hospice and psychiatric care; minor medical centers and clinics; a network of surgery, rehabilitation and other outpatient centers; and an education system highlighted by Baptist Health Sciences University (formerly Baptist College of Health Sciences). Baptist employs more than 21,000 people, and in fiscal year 2022 contributed more than $455 million in community benefit and uncompensated care to the communities it serves. For more information, please visit www.baptistonline.org or follow us on Facebook or Instagram.
Offices: 350 N Humphreys Blvd, Memphis, Tennessee 38120, US
HospitalHealth CareRehabilitationNon ProfitWellnessMedicalGovernmentNursing and Residential Care
How many Administrative jobs are open in Memphis, TN right now?
There are currently 1,221 open administrative positions in Memphis, TN listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Administrative roles in Memphis, TN?
Companies currently hiring include Memphis-Shelby County Schools, Baptist Memorial Health Care, Regional One Health, Methodist Le Bonheur Healthcare, Tennessee Board of Regents (TBR), among others. Browse the listings above to see every active employer.
Are there remote or hybrid Administrative jobs in Memphis, TN?
Yes — 61 of the 1221 open administrative positions offer remote or hybrid work (23 remote, 38 hybrid).
How do I apply for Administrative jobs in Memphis, TN?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.