JOB SUMMARY: Responsible for network development; negotiating, monitoring and managing the contractual
relationship of assigned provider contracts. Working in coordination with Compliance, Provider Relations and Network
Management, negotiates and finalizes provider contract language and rates, including amendments for existing
contracts and establishment of new ones. Contracts for physician, hospital, ancillary and delegation of services for
Medicaid and any other programs CHC may develop. Responsible for Provider contract compliance. Coordinates with
Network Management, Claims and Health Services to ensure adequate set up and comprehensive interpretation of
new contract fees and requirements. Assists with provider profiling, working closely with Finance, Provider Relations,
Member Services, Health Analysis and Health Services to provide reports, assist with analysis and recommend actions.
Reviews quantitative analysis of various types of data including provider contracts, fee schedules, utilization and claims
data needed for assessing, planning, budgeting, cost control and contract administration and makes recommendations
for contracting rates and policies.
MINIMUM QUALIFICATIONS:
1. Education/Specialized Training/Licensure: Bachelor's degree in Marketing, business or related field; may substitute
experience for education.
2. Work Experience (Years and Area): 5+ years in healthcare, with at least 3 years experience Providers /
Managed Care, Contracting and Relations.
3. Management Experience (Years and Area): N/A
4. Equipment Operated: PC and own transportation
SPECIAL REQUIREMENTS: (Check Applicable Areas)
1. Communication Skills:
Above Average Verbal (Heavy Public Contact)
Writing /Composing (Correspondence / Reports )
2. Other Skills:
Analytical Medical Terms Statistical P.C. MS Word MS Excel
3. Advanced Education:
4. Work Schedule: Flexible
5. Other Requirements:
Must have car and valid Texas Drivers license. Must have managed contract negotiation
experience, preferably in Houston market.
RESPONSIBLE TO:
Director
EMPLOYEES SUPERVISED:
None