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Senior Provider Network Contract Specialist
Providence. Develop and maintain the Network Plan and provider handbook .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managed care operations, network adequacy evaluation, and compliance with URAC and DoD standards. Proficient in contract negotiation and establishing collaborative relationships with community stakeholders.
Highest-signal resume keywords
Managed Care Operations ExperienceContract Negotiation ExperienceUnderstanding Of Capitated MedicineHealth Plan Contracts ExpertiseProject Management Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Network Adequacy EvaluationCompliance With URAC StandardsCompliance With DoD StandardsNon-Clinical Utilization ManagementProvider ContractingContract Language NegotiationAmbulatory Medicine Knowledge
Soft Skills
Effective CommunicationRelationship BuildingCollaboration
Industry Keywords
TRICARE Management Activity ContractUS Family Health PlanCapitated MedicineHealth Plan CriteriaStakeholder Engagement
About the role
Key responsibilities & impact- Develop and maintain the Network Plan and provider handbook
- Evaluate network adequacy
- Ensure the network meets URAC and DoD standards
- Ensure compliance with all elements of the TRICARE Management Activity contract
- Establish effective working relationships with community stakeholders to increase resources and collaboration
- Represent and serve as spokesperson for US Family Health Plan internally and externally
- Educate providers and network members on Health Plan criteria and processes
- Manage non-clinical utilization management functions of the Health Plan
- Ensure compliance with the DoD contract regarding network and utilization issues
- Support provider contracting and network relations
- Lead contract negotiations for reimbursement terms and contract language with hospitals, physician groups, and ancillary service providers
- Conduct negotiations and complete contracting processes in accordance with USFHP contracting principles, organizational policies, procedures, and the TRICARE Management Activity contract
Requirements
What you’ll need- 5 years of managed care operations experience
- Extensive experience and understanding of capitated medicine
- Extensive experience and understanding of contracted networks
- Extensive experience and understanding of health plan contracts
- Bachelor’s Degree in a related field preferred
- Experience with ambulatory medicine preferred
- Project management experience preferred
- Contract negotiation experience preferred
Benefits
Comp & perks- Retirement 401(k) Savings Plan with employer matching
- Medical, dental, and vision health care benefits
- Life insurance
- Disability insurance
- Paid parental leave
- Vacation time
- Paid holidays
- Paid time off for health issues
- Voluntary benefits
- Well-being resources
- Inclusive workplace and professional career support