Provider Relations and Contract Manager

The Provider Relations and Contract Manager is a critical member of Fulcrum’s Network Management team. The position supports Fulcrum’s network recruitment and development initiatives and functions as a liaison between providers, the organization and its customers. Responsibilities include driving Fulcrum’s provider network expansion efforts, creating targeted recruitment collateral, performing detailed market analysis and intelligence gathering as well as maintaining network KPI reports and performance dashboards. In addition, this role will assist provider training, orientation, and coaching for performance improvement within the network. This is a hybrid position requiring an on-site presence at our Plymouth, MN, office up to three days a week. Only local candidates will be considered for this role.

ESSENTIAL FUNCTIONS:

Network Development and Recruiting

• Develop geographically competitive, broad access, stable networks that achieve Fulcrum client objectives for performance, network adequacy and accessibility of provider specialty types.
• Recruit and develop provider networks to meet on-going business and client benefit needs.
• Engage and contract with independent practitioners and provider groups to join Fulcrum network(s).
• Respond in a timely manner to provider inquiries regarding contracting requests.
• Research and help resolve provider contract and utilization management issues.
• Ensure providers have proper documentation to join and remain in the network.
• Ensure welcome packets including welcome letters, quick reference guides and countersigned contracts are sent to providers in a timely manner.
• Communicate regularly with internal and external customers regarding the status of project, with specific attention to delays, issues, or changes to the project timelines.
• Participate in the development of business strategy to achieve contract objectives.
• Adapts departmental plans and priorities to address business and operational challenges.
• Working cross functionally, design and implement recruitment strategy and supporting collateral to support Fulcrum network expansion and practitioner development initiatives.
• Maintain provider manual, policies, fee schedules, and year-end letters.

Market Intelligence and Analysis

• Provide insightful competitive intelligence to inform leadership of industry trends, market composition and best practices related to provider network expansion.
• Utilize technology tools and dashboards to track trends, generate reports and analyze expansion metrics to inform progress and support network management strategies.
• Working cross functionally, develop clinical performance metrics and create reports for business partners and clients.
• Conduct periodic audits to ensure network adequacy requirements are met and ensure compliance with applicable regulations and polices.
• Perform other related duties and projects as assigned.

REQUIRED QUALIFICATIONS: (Minimum qualifications needed for this position)

Education:

• Bachelor’s degree preferred or equivalent experience.

Knowledge and Skills:

• 3+ years of experience within health care industry handling complex network providers with accountability for business results.
• 3+ years experience in the health care industry.
• 3+years of experience in a network management-related role, such as contracting or provider services.
• Knowledge of health care, managed care, Medicare and Medicaid.
• Strong, effective communicator capable of navigating challenging conversations.
• Excellent organizational, interpersonal, presentation, facilitation, and communication skills.
• Demonstrated commitment to high professional ethical standards.
• Ability to adapt to a fast paced, continually changing business and work environment while managing multiple priorities.
• Excellent follow-through skills; self-motivated and detail-oriented.
• Strong organizational skills to manage multiple projects, issues, and priorities effectively and simultaneously, with attention to detail.
• Intermediate to Expert level proficiency in the MS Office Suite (MS Word, Excel and Outlook).

PREFERRED QUALIFICATIONS:

• Understanding of managed care, health care contracting principles, applications, and products.
• Experience in provider relations and provider network management, provider and network development.
• Demonstrated experience developing and maintaining high performing practitioner networks, ie: tiered, narrowed, value based, etc.
• Strong analytical skills to aid assessment of potential program opportunities, market expansion and evaluation of quality performance initiatives.
• Working knowledge of claims processing systems and guidelines.
• Knowledge of reimbursement strategies /methods including Medicare Resources Based Relative Values System (RBRVS) methodology.
• Demonstrated ability to lead multiple high profile projects and see them to completion.

DIRECT/INDIRECT REPORTS:

• Number of direct reports: 0
• Number of indirect reports: 0

Work Location:

• Plymouth, MN (hybrid).

Fulcrum Health, Inc.