JOB SUMMARY:

The Director of Provider Contracting provides strategic leadership in the development, direction, execution, and evaluation of an effective contracting program. The Director is responsible for assuring the program supports the delivery of quality providers appropriately and effectively, and that meets all contractual and regulatory requirements. This position develops and maintains a robust provider network that meets state-defined accessibility standards and incorporates continuous quality improvement and effective outreach programming. In addition, the Director develops systems to ensure effective coordination between network providers and contracting and ensures the analysis of utilization and cost data is translated to program implementation. Assures that network and contracting function are aligned with organizational strategic objectives and financial targets.

MINIMUM QUALIFICATIONS:

1. Education/Specialized Training/Licensure:
   • BA/BS; 4 years equivalent work experience may substitute for degree requirement.
2. Work Experience:
   • 7 years in healthcare, with at least 5 years experience in Providers/Managed Care Contracting. Health Plan experience preferred. Must have medical contract negotiations experience, preferably in Houston market.
3. Management Experience:
   • 4 years of direct supervision experience required
4. Software Operated: Microsoft Office (Word, Excel, Outlook)

Other Requirements

• Must have car and valid Texas Drivers license
• Contracting experience with both hospital and physician practice (group practice and solo practitioner) required.
• Skilled at developing and implementing strategic objectives for the contracting function.
• Experience with implementing provider incentive programs and pay-for-quality programs.
• Experience with claims payment and CRM systems required. QNXT and Salesforce preferred.
• Demonstrated ability to manage and develop staff in medical contract negotiation.

SPECIAL REQUIREMENTS:

• Communication Skills:
• Above Average Verbal (Heavy Public Contact)
• Writing /Composing: Correspondence / Reports
• Other Skills: Analytical, Medical Terminology, Statistical, MS Word, MS Excel
• Advanced Education: Bachelors Degree
• Work Schedule: Flexible

RESPONSIBLE TO: Vice President

EMPLOYEE SUPERVISED: Professionals and Clerical Staff