Provider Relations Contracting Consultant

Group 1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Company Overview:

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina and offers Medicare Prescription Drug Plans in 42 states plus DC.

Location: Remote, supporting Colorado

Company Overview

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security.  Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina.  In addition, Clear Spring Health sponsors Medicare Prescription Drug plans in 42 states.

Job Summary

The Market Engagement Director will serve as the primary business owner for Clear Spring Health in their associated region. This includes responsibility over all local network management, network growth and customer acquisition activities. Key relationship holder with both the provider and broker community. They will develop and implement contract structures and reimbursement methods to align with provider network to improve the measurable performance of the market and improve the quality of care for Clear Spring Health customers. Maintain key relationships to improve total medical cost and position in the market for growth opportunities.

Main Accountabilities

• Initiating and maintaining long-term relationships with all large and/or critically important medical providers, integrated provider systems, long-term services and supports, and provider networks
• Coordinate, negotiate and handle activities related to network development, provider contracting, and/or provider relations functions.
• Negotiate large hospital, physician groups and ancillary service agreements in accordance with corporate and government regulations and guidelines.
• Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
• Develop and implement local marketing and growth strategies through broker relationships
• Perform basic financial analyses to identify medical cost improvement opportunities, develop strategies to reach financial goals, and execute contracting strategies to meet goals and objectives.
• Identify and manages initiatives that improve total medical cost and quality.
• Initiates, nurtures and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing.

Qualifications:

• Education/Experience: Bachelor's degree in Business Administration, Health Care Administration, Finance, related field or equivalent experience.
• Extensive market knowledge and existing relationships within the local healthcare community
• 5+ years of related experience negotiating hospital, large physician groups and ancillary service agreements and external customer service for providers.
• Intimate understanding and experience with larger, more complex integrated delivery systems, managed care, and provider business models.
• Experience in provider network management and Medicare contracting, specifically focused on risk and value-based care.
• Experience in marketing/sales, medical economics and financial statements in a managed care or insurance environment
• Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
• 50% interstate travel with potential overnight travel
• Daily local travel to attend meetings in the filed
• This opportunity is located “Remote” from home office, however, requires daily local travel to meetings within Colorado.

Compensation:  

Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay for this position ranges from $100,000/year in our lowest geographic market up to $120,000/year in our highest geographic market.  Pay is based on a number of factors including market location and may vary depending on job-related knowledge, skills, and experience. 

Benefits Highlights:  

Employees who meet benefit eligibility guidelines and work 30 hours or more weekly, have the ability to enroll in Group 1001’s benefits package. Employees (and their families) are eligible to participate in the Company’s comprehensive health, dental, and vision insurance plan options.  Employees are also eligible for Basic and Supplemental Life Insurance, Short and Long-Term Disability, and to enroll in the Company’s Employee Assistance Program and other wellness initiatives.  Employees may also participate in the Company’s 401K plan, with matching contributions by the Company. 

Group 1001, and its affiliated companies, is strongly committed to providing a supportive work environment where employee differences are valued. Diversity is an essential ingredient in making Group 1001 a welcoming place to work and is fundamental in building a high-performance team. Diversity embodies all the differences that make us unique individuals.  All employees share the responsibility for maintaining a workplace culture of dignity, respect, understanding and appreciation of individual and group differences.

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