Director Network Contract CoordLocation: Alternate locations may be considered. This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our PulsePoint locations.The Director Network Contract Coord is responsible for managing and negotiating contracts with large home health (HH), durable medical equipment (DME), large vendors and aggregators to ensure a home health agency can provide services to patients while maintaining financial viability; their key duties include identifying the best contract payment model, negotiating contract terms, monitoring compliance with contract agreements, and minimizing year over year units costs for Carelon Medical Benefits Management businesses.How you will make an impact:
Lead contract negotiations with home health (HH), durable medical equipment (DME), and other ancillary providers and vendors which include negotiating reimbursement rates, service offerings, utilization management, and quality metrics.
Develop and maintain strong relationships with key decision-makers at payer organizations to understand their needs and advocate effectively for the agency's interests.
Analyze contract terms to assess financial implications, identify potential risks, and ensure compliance with regulatory requirements by staying updated on industry trends, payer regulations, and market dynamics to identify new contracting opportunities.
Develop financial projections and forecasts based on potential contract agreements to evaluate their impact on the agency’s revenue and profitability.
Regularly monitor contract performance, including utilization rates, reimbursement levels, and adherence to contract terms.
Collaborate with clinical teams to identify areas for quality improvement related to contract requirements and patient care.
Lead and mentor a team of contract specialists responsible for managing specific payer relationships and contracts, ensuring the contract administration goals are obtained and maintained.
Direct the contract administration policies and standards, providing strategic oversight of the contract administration function within a given unit.
Identify contract administration information needs and technologies and manage the annual operating budget within financial objectives.
Hire, train, coach, counsel, and evaluate the performance of direct reports, supervising workflow and performance.
Provide quality control services through the monitoring of work results and performing audits to ensure compliance with departmental policies and procedures.
Develop and implement associate training and prepare reports to support the organization’s objectives.
May be assigned to special project work consistent with the role and dictated by the business needs.
Minimum Requirements:Requires Bachelors degree in a related field and minimum of 5 years equivalent work experience in provider contracting, or any combination of education/experience that would provide an equivalent background.Preferred Skills, Capabilities, and Experience:
Over 5 years of experience in healthcare contracting, with direct expertise in negotiating contracts with large home health (HH) and durable medical equipment (DME) providers, as well as service vendors strongly preferred.
Proven track record of successfully negotiating and managing provider contracts, with a comprehensive understanding of the home health and DME industry, including billing codes, reimbursement mechanisms, and the regulatory landscape strongly preferred.
Deep knowledge of Medicare, Medicaid, and Commercial business practices related to home health, DME, and other post-acute services strongly preferred.
Proven ability to negotiate complex contracts with payers, securing favorable terms for the agency preferred.
Strong analytical skills for interpreting financial data and making informed decisions regarding contract profitability strongly preferred.
Exceptional strategic thinking, decision-making, and problem-solving skills, with demonstrated adaptability preferred.
Experience in collaborating with cross-functional teams and coordinating efforts towards common goals preferred.
Confidence in interacting with senior management and executive-level stakeholders as a subject matter expert, with comfort in influencing decision-making preferred.
Excellent written, oral, presentation, and interpersonal communication skills, with a proven ability to negotiate expectations between multiple parties highly preferred.
Experience using CONGA contracting tools is preferred.
Proficiency in Microsoft Office products, particularly in PowerPoint and Excel preferred.
For candidates working in person or remotely in the below location(s), the salary range for this specific position is $130,452 to $223,632Locations: District of Columbia (Washington, DC); Illinois; Maryland, Minnesota; New YorkIn addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Who We AreElevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.How We WorkAt Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.