MISSION, VISION AND VALUES

“Making Healthcare Right. Together.” is the cornerstone of all we do. Our vision is to collaborate with Care Partners to make health care simpler, personal and more affordable. To successfully achieve our mission and vision as we operate in a dynamic health care environment, we expect Bright People to embody and uphold our core values in work and interactions, both internal and external: Be Purposeful, Be Authentic, Be Brave, Be Positive, Be Respectful, and Be Accountable.

SCOPE OF ROLE

The Network Development team is responsible for partnering with our care providers to turn our provider networks into market leading integrated delivery systems. We are reimagining how the network development, network management, and provider relations functions can advance affordable, simple, and personal care for our members.

The Senior Provider Contract Specialist will be a key contributor to our Network Development team and a thought leader for provider networks. This position will play an integral role in driving the company’s performance by building, optimizing, and transforming our provider networks. This position will be responsible for developing and maintaining provider relationships and negotiating participation agreements with key local care providers as well as for advancing reimbursement best practices.

ROLE RESPONSIBILITIES

• Lead the provider contracting efforts from start-to-finish, including but not limited to process oversight, strategic diligence, outreach, and contract negotiations with large and small physician groups and ancillary providers and mid-sized and large hospitals and health systems
• Effectively negotiate rates, structures, and contract language with a range of provider types across multiple geographies
• Support collaboration with our care providers to analyze, design, and develop networks through ongoing evaluation of both current and potential network participants
• Support and enhance Bright Health’s portfolio of strategic national and multi-regional network partnerships to compliment local network development efforts
• Manage ongoing network participation and performance, including performance analytics and management, as well as contract renewals and terminations
• Partner with stakeholders across the organization including, but not limited to sales, finance, regulatory and medical management to drive strategic priorities and initiatives
• Monitor utilization trends for non-participating providers and execute on organizational strategies to ensure members are seeking care with participating providers when appropriate

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• At least four (4) years of experience within the healthcare industry with at least two (2) years of experience in network development, network management or reimbursement model design required
• Bachelor’s degree in business, economics, healthcare administration or a related field is preferred.  Additional equivalent experience is preferred in lieu of a Bachelor’s degree.
• Experience with successful execution and implementation of payer-provider contracts or partnerships required.
• Experience with developing, presenting and analyzing various types of financial analyses in order to make informed strategic decisions preferred.
• Experience working with dental, vision and other provider networks for supplemental / ancillary benefits preferred
• Experience commercializing digital health and clinical products to consumers, patients, members, and/or providers preferred
• Proficiency in Windows-based computer applications-Microsoft Word, Microsoft Excel and Microsoft Power Point-is required

PROFESSIONAL COMPETENCIES

• Strong attention to detail and analytical skills; ability to organize and analyze data
• Superb written and verbal communication skills with an ability to effectively collaborate with internal and external executive leadership
• Ability to collaborate cross-functionally across departments and various level roles in the organization
• Able to manage time effectively, understand directions, and work independently in a fast-paced environment
• Willingness to learn and operate in ambiguity
• Desire and ability to move quickly between strategic leadership, tactical execution, and managing analytics
• Knowledge of managed care practices and procedures, specifically in contracting language and negotiations
• Ability to effectively engage providers, ranging from national providers to regional integrated delivery systems to local physician practices
• Able to make decisions regarding own work methods, requires minimal direction and receives guidance where needed. Follows established guidelines/procedures
• Excellent multitasking and prioritization skills with a proven ability to manage multiple projects in parallel to completion

BEHAVIORAL AND LEADERSHIP NORMS

• Bright Values:  Exemplifies Bright Values. Leads by example. Is viewed as key leader in the company. Acts with quiet, calm determination. Effectively influences inside of the organization.
• Decision making:  Has a strong voice and is a contributor in the decision-making process.  Is sought out in the organization for input in driving to a decision. Makes decisions based on fact. Is capable of taking large amounts of information, and drilling into what is important. Understands organizational impact of decisions and communicates effectively throughout the decision-making process.  Pushes issues to resolution.
• Delivers Results: Is extremely results oriented.  Is capable of deciphering priorities for self and for others, and focuses the group on what must be done today and who must do what. Focuses on results, not effort, and is able to efficiently direct time and energy to achieving intended outcome.  Can successfully develop a budget and achieve it without sacrificing quality of output. Achieves strong results within functional area and understands organizational impact.  Excellent track record of achieving or surpassing expected results. Understands how to operate in collaborative framework; results should not come at expense of other team or function.
• Direct and Indirect Management:  Makes decisions that benefit Bright over self. Is developing within the framework of the Bright Leadership Model, and can successfully influence direct and indirect teams to achieve goals. Organizes people and resources toward the effective and efficient pursuit of objectives. Delivers thoughtful and constructive feedback to teams, and actively works to develop those around them. Sets an example for employees. Is sought after by peers for 360 feedback. Manages up appropriately and knows how and when to escalate an issue or situation to a more senior manager.
• Planning and Execution:  Identifies need for planning and has skills to develop, implement, monitor and achieve plans. Knows how and when to adjust plans.  Leads others in this effort. Holds self and team accountable for effective planning and execution.  Overcomes hurdles.
• Presence: Excellent communication skills and represents Bright well. Participates in external meetings (ex. With Care Partners, vendors, regulatory bodies, etc.). Internally, leads large and small groups of people in meetings. Capable of developing a thoughtful agenda, setting objectives, driving clarity of purpose and delivering the intended results. Instills confidence in others.