Provider Contracting Manager III

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We’re a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration – because success is a team sport. It’s our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

Develop and maintain provider networks yielding a competitive, geographic, stable network that achieves objectives for unit cost performance and trend management. Produce an affordable and predictable network for customers and business partners. Evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establish and maintain strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensure the network composition includes an appropriate distribution of provider specialties.

Perform other duties as assigned.

• Contract Lifecycle and Management
  • Negotiate and draft contracts:
    Negotiate terms with providers, ensuring they align with Medica’s financial goals and standard template agreements.
  • Manage contract renewals and amendments:
    Track critical dates, manage the renewal process, and handle amendments as needed.
  • Maintain contracts:
    Keep contractual language and fee schedules up-to-date with current medical policy changes and reimbursement structures.
  • Oversee the entire contract lifecycle:
    Manage all stages, from initiation and negotiation through execution, monitoring, and closure.
• Provider Relationships and Network Management
  • Build and maintain relationships:
    Develop and nurture strong relationships with providers, including high-level representatives of key contracting entities.
  • Resolve issues:
    Manage provider relations, address issues, and lead dispute resolution processes.
  • Conduct performance assessments:
    Regularly evaluate the performance of assigned networks and providers to identify areas for improvement.
  • Support network growth:
    Participate in activities related to network adequacy, provider recruitment, and marketing for providers.

• Bachelor’s degree or equivalent experience in related field
• 5 years of work experience beyond degree in contract negotiations and healthcare

• WI market knowledge preferred
• Basic health plan operations and/or provider operations experience
• Excellent communication (written, verbal, and presentation) skills
• Proven track record of cultivating and maintaining effective, collaborative external relationships where the parties trust information that’s conveyed
• A proven track record as a successful contract negotiator for health care services, provider or health plan
• Flexibility and creativity in developing effective contracting terms
• Knowledge of provider contracting components and strategies such as but not limited to risk-based contracting, financial models, operational impact, and data analytics
• Demonstrated understanding of complex financial arrangements and quality programs across health care products
• Strong financial, analytical and problem-solving skills, and understanding of legal documents
• Strategic-thinking skills with the ability to conceptualize a wide range of scenarios and the ability to analyze each scenario to come up with the most viable option

This position is an office role, which requires an employee to work onsite at our Madison, WI office or Minnetonka, MN, on average, 3 days per week.

The full salary grade for this position is $77,100 - $132,200. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $77,100 - $115,710. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications…