Medica jismoniy shaxslar, oilalar, ish beruvchilar hamda Medicare va Medicaid dasturlariga a’zo bo‘lganlar uchun xizmat ko‘rsatuvchi notijorat tibbiy sug‘urta tashkiloti va tibbiy reja hisoblanadi. Uning faoliyati tibbiy rejalarni boshqarish, a’zolarni qo‘llab-quvvatlash, tibbiy xizmat ko‘rsatuvchilarni izlash vositalari, imtiyozlar va da’volarni boshqarish, salomatlik dasturlari hamda odamlarga tibbiy xizmatlardan foydalanishda yo‘l topishga yordam beradigan boshqa resurslarni qamrab oladi. Tashkilot Medica Foundation orqali sog‘liqni saqlashda tenglikni rivojlantirishga qaratilgan, jamoalarga yo‘naltirilgan tashabbuslarni ham qo‘llab-quvvatlaydi va sog‘liqni saqlash hamda sug‘urta sohalarida ishlaydigan mutaxassislar uchun missiyaga asoslangan muhit yaratadi.
Provider Contract Manager II - Medica (Remote, United States)
Manage healthcare provider contracting for Medica by negotiating reimbursement terms, strengthening provider networks, and supporting competitive, compliant network performance. Use claims, cost, utilization, market, and financial data to guide contracting decisions and improve network outcomes.
Tavsif
- Build and maintain competitive, geographically stable provider networks aligned with unit-cost and trend-management goals
- Assess network adequacy, market conditions, provider availability, and specialty coverage
- Review and negotiate provider agreements, reimbursement models, and proposed contract terms
- Lead routine negotiations with physicians, ancillary providers, and smaller facilities
- Verify that contracts follow approved templates, reimbursement standards, legal requirements, and documentation practices
- Evaluate the financial effects of proposed terms and escalate exceptions appropriately
- Handle routine provider contract inquiries, relationship matters, and escalations
- Communicate performance measures, contract requirements, and network initiatives to stakeholders
- Help providers understand reimbursement methodologies, operating workflows, and administrative processes
- Participate in provider meetings and workgroups
- Examine claims, cost, and utilization data for patterns that inform contracting decisions
- Apply market intelligence, benchmarking, and analytical models to create negotiation strategies, summaries, and recommendations
- Monitor competitor activity and regulatory changes that may affect network structure
- Identify improvements to contracting workflows, tools, and documentation
- Work with legal, finance, provider operations, and clinical teams to implement contracts
- Contribute to value-based contracting, quality programs, and cost-of-care initiatives
- Exchange contracting knowledge and effective practices with colleagues
Talablar
- Bachelor’s degree or equivalent experience in a related field
- At least three years of post-degree experience in contract negotiations, along with healthcare Wisconsin market knowledge within provider contracting
- Basic knowledge of health plan operations and/or provider operations
- Excellent written, verbal, and presentation abilities
- Capacity to work independently, exercise sound judgment, and recognize when escalation is necessary
- Demonstrated ability to build and sustain effective, collaborative external relationships
- Successful experience negotiating contracts for healthcare services, providers, or health plans
- Adaptability and creativity when developing effective contracting terms
- Knowledge of provider contracting components and strategies, including risk-based contracting, financial models, operational impact, and data analytics
- Demonstrated understanding of complex financial arrangements and quality programs across healthcare products
- Strong financial, analytical, and problem-solving capabilities
- Ability to understand legal documents
- Strategic thinking and the ability to evaluate scenarios and identify viable options
- Primary home address must be in a state where Medica is registered as an employer: AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, or WI
- Legal authorization to work in the United States at the time of application
- Medica does not provide work visa sponsorship for this position
Imtiyozlar
- Medical, dental, and vision coverage
- Paid time off
- Paid holidays
- Paid volunteer time off
- 401(k) contributions
- Caregiver support services
- Incentive-plan compensation may be available in addition to base pay
- Additional benefits designed to support employees