South Country Health Alliance · 3 weeks ago
Associate Director of Provider Network and Contracting
Medford, MN
Full-time
Onsite
Lead/Staff, Director/Executive
$117K/yr - $140K/yr
5+ years expSouth Country Health Alliance is seeking an Associate Director of Provider Network and Contracting to join their team. In this role, you will provide operational direction and leadership to the Provider Contracting and Provider Relations teams to secure and maintain competitive contractual relationships with providers while ensuring adherence to regulatory and operational goals.
Health CareNon ProfitWellness
No H1B
Responsibilities
Coach, mentor, and manage a team of professionals to achieve favorable and timely contract terms, build and strengthen relationships with key providers, and support South Country’s strategic provider-related goals
Lead, develop and implement South Country’s provider network contracting activities, and responding to access and availability enhancement goals. Bring provider market intelligence and insights to key internal provider forums to inform direction and decisions
Along with the Compliance Officer and the CFO, negotiate contractual relationships with providers that support SCHA’s strategic, financial, operational, and program-specific goals, utilizing an appropriate reimbursement methodology consistent with network strategy and contracting goals. Ability to work with outside consulting actuaries on structure and financial modeling of programs
Develop an annual contract renewal and negotiation plan in collaboration with teams and other internal stakeholders. Report status quarterly to South Country leadership and key committees
Maintain a working knowledge of State of MN and CMS provider reimbursement methodologies and other relevant strategies and ensure this information is presented to South Country operational areas as may be relevant to support South Country’s policies and strategies
Develop and maintain network oversight plans by provider/network type. Ensure contractual, regulatory and NCQA compliance for network providers
Support program management efforts related to unique Medicare and Medicaid networks. Ensure departmental staff members align work efforts with enterprise-wide goals and objectives for these networks/services
Work effectively with South Country’s Compliance Officer, CFO, leadership, program managers, operations staff and selected third party administrators to ensure that the South Country provider contracts are understood and interpreted (for system implementation) for accurate administration
Other duties assigned within the scope, responsibility and requirements of the job
Qualification
Required
Bachelor's degree in a health care or business-related field or other relevant field
Five years' experience in health care delivery setting (e.g., hospital, health insurance, HMO or community service provider, physician group practice)
Three years' experience in contract and pricing management in health care
Knowledge of both State Public Programs (MN Medicaid) and Medicare (dual) products
Direct contracting and negotiation experience with providers
Preferred
Knowledge of and experience with provider credentialing and related processes
Benefits
Comprehensive benefits: Medical, dental, vision, life insurance, short- and long-term disability, pension (PERA), and more.
Work-life flexibility: Hybrid and remote options with quarterly on-site expectations.
Predictable pay growth: Structured step-based salary system for transparency and stability.
Company
South Country Health Alliance
South Country Health Alliance is a county-based health plan that offers an array of Medicaid, Medicare and health promotion programs.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Leota Lind
CEO
Company data provided by crunchbase