It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The WellSense Health Plan Manager of Hospital and Physician Contracts is responsible for the development, implementation and management of a cost-effective provider network, maintaining complex and geographically diverse contracts. The Manager leads a team of Hospital and Physician Contract Managers and is responsible for the development of network-wide strategies to improve efficiencies and access. Under the direction of the Director of Provider Contracting, the Manager is accountable for the end-to-end planning and execution necessary to assess, develop, maintain and/or improve provider network adequacy and performance.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Interprets environmental (policy, contract, landscape, organizational) changes with contracting and provider impact. Guides internal response strategies.
• Oversees and guides a team of Hospital and Physician Contract Managers:
• Gathers and analyzes data and other relevant intelligence in assessing provider network adequacy against required standards and business expectations;
• Identifies, assesses and develops strategies for improving provider and network cost, utilization and quality performance;
• Leads negotiations of financial and other contractual terms, including risk sharing terms;
• Ensures all contract terms and conditions comply with financial and legal requirements of WellSense and its regulatory entities (e.g., MassHealth, MA Division of Insurance, EOHHS)
• Develops and maintains business relationships with high-level representatives of key contracting hospitals, physicians and ancillary service providers;
• Participates in the development, implementation & continuous improvement of departmental policies, procedures, workflows, and tools as they relate to network development and provider contracting;
• Represents the department and organization supporting internal and external initiatives including state regulators;
• Performs other duties as required to accomplish departmental and corporate goals & objectives;

Supervision Exercised:

• Supervises a staff of Hospital and Physician Contract Managers.

Supervision Received:

• General supervision is received weekly from the Director of Provider Contracting.

Qualifications:

Education Required:

• Bachelor's Degree or the equivalent combination of education and experience in provider network management required

Education Preferred:

• Master's degree preferred

Experience Required:

• At least 5 years of senior level provider network contracting experience
• Minimum of 3 years of management experience

Experience Preferred/Desirable:

• Medicaid managed care experience preferred

Required Licensure, Certification or Conditions of Employment:

• Pre-employment background check

Competencies, Skills, and Attributes:

• Interpersonal and leadership style necessary to serve as 'go-to' resource for colleagues;
• Proven analytical skill in assessing and projecting financial, utilization and quality performance on an individual provider and network basis;
• In-depth knowledge and understanding of contract finance and provider reimbursement methodologies, including risk, shared savings, pay-for-performance and other financial incentive strategies;
• In-depth knowledge and understanding of current healthcare industry issues and trends, including national and state-level payment reform landscape and strategy (e.g., accountable care and patient centered medical home); especially including but not limited to: SNF, VNA, Rehab and LTAC.
• Proven negotiation skills with hospitals, Integrated Delivery Networks, physicians service providers;
• Proven skill in critical thinking and strategic planning and implementation;
• Knowledge of federal and state Medicare, Medicaid, and relevant guidelines, regulations and standards;
• Effective communication (verbal and written) and relationship building skills. Position will interact with internal and external executive teams;
• Expertise in Microsoft Office programs and industry-standard financial applications as appropriate.
• Understanding of health plan operations;

Working Conditions and Physical Effort:

• Work is normally performed remotely with some travel to providers and office
• No or very little physical effort required;
• No or very limited exposure to physical risk.
• Regular and reliable attendance is an essential function of the position.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.