Senior Contract Manager (NH)

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 Senior Contract Manager is responsible for the development, implementation and management of a cost-effective New Hampshire provider network, maintaining complex and geographically diverse contracts. Serves as mentor to Contract Managers, assisting in the development of network-wide strategies to improve efficiencies and access. Under the direction of the Director of Contracting & Provider Engagement, s/he performs all critical functions 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

* 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 Well Sense Health Plan and its regulatory entities (e.g., NH DHHS

* 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

* Performs other duties as required to accomplish departmental and corporate goals & objectives

Qualifications:

Experience:

* 5-10 years' experience, some in senior position

* Medicaid managed care experience preferred

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)

* Proven negotiation skills with hospitals, Integrated Delivery Networks, physicians and ancillary 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

Compensation Range

$96,000- $139,500

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

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. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees