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Contract and Network Development Specialist

    • Job Tracking ID: 512689-708214
    • Job Location: Milwaukee, WI
    • Job Level: Mid Career (2+ years)
    • Level of Education: BA/BS
    • Job Type: Full-Time/Regular
    • Date Updated: November 26, 2019
    • Years of Experience: 5 - 7 Years
    • Starting Date: ASAP
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Job Description:

The purpose of the Network Development Contract Specialist (NDCS) position is to develop and maintain a robust network of contracted providers to meet the needs for iCare membership and all lines of business.  The NDCS proactively engages all levels of providers to achieve iCare goals and objectives, participates in the development of new provider networks, and successfully negotiates provider contracts favorable to iCare’s business objectives.  This position will effectively interact with providers, iCare department leaders, and iCare staff to assure contract compliance as well as clearly communicate with other iCare departments to assure that all applications properly reflect the contracted services and other negotiated contract terms.

This position effectively and efficiently develops and maintains a network of contracted providers to meet the needs for iCare membership and lines of business.

  1. Develops the iCare’s provider network to best serve the needs of iCare enrollees.

  2. Works in collaboration with internal staff to complete and periodically update market analyses to determine network adequacy and identify network development needs.

  3. Participates in development of contracting strategy, including analysis of provider contracts, scope of provider services and provider profiles.

  4. Develops, in collaboration with iCare leadership and staff, strategies to engage providers around iCare goals for improvement in quality and service to members

  5. Participates in the assessment of the network development opportunities for new products, lines of business and expansion markets.

  6. Negotiates and prepares agreements and contracts for providers to achieve financial and non-financial goals according to iCare policy and limitations.

  7. Assists in the development of policy, procedures and protocols for provider data base setup and maintenance.

  8. Facilitates iCare credentialing process or credentialing delegation process

  9. Responds to requests from providers relative to contact concerns, problems and issues; conducts necessary research and analysis and responds verbally or by correspondence as appropriate.

  10. Interacts with other departments and seeks appropriate resolution to provider/contract issues. Advises internal staff on issues related to provider contracts and network.

  11. Delivers reports summarizing contracting and other activity periodically to management as requested

  12. Maintains compliance with all regulatory requirements.

Experience and Skills:

  1. Broad knowledge of health care marketplace including hospital, physician and other long term care providers.

  2. Minimum of 5 years’ experience in health insurance/managed care environment with knowledge of Medicaid and Medicare benefits and services and including provider contracting experience.

  3. Bachelor’s degree in business administration, health care administration or related field, preferred.

  4. Excellent negotiation and problem-solving skills.

  5. Excellent oral and written communication skills; especially demonstrated telephone skills.

  6. Demonstrated knowledge of keyboard, Word, Excel, PowerPoint, email, and other office software applications.

  7. Must have own vehicle and valid driver’s license for work-related travel.