Contract Manager, BH Network Strategy - WellSense Health Plan

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

Reporting to the Manager of Behavioral Health Network Strategy, the Contract Manager for Behavioral Health Network Strategy facilitates development, implementation and management of cost-effective provider networks.Under the direction of the Manager of Behavioral Health Network Strategy, the Contract Manager performs all critical functions necessary to assess, develop, maintain and/or improve provider network adequacy and performance.

Our Investment in You:

·Full-time remote work

·Competitive salaries

·Excellent benefits

Key Functions/Responsibilities:

·Lead negotiations of financial and other contractual terms for behavioral health agreements for the Medicare, Medicaid and Commercial suite of products

·Ensure all contract terms and conditions are in compliance with financial, legal and regulatory requirements and align with company goals

·Gather and analyze data and other relevant intelligence in assessing provider network adequacy against required standards and business expectations

·Monitor and evaluate provider performance using key identified metrics to ensure compliance with contractual terms and improved outcomes

·Identify, assesses and develops strategies for improving provider and network cost, utilization and quality performance

·Develop and maintain effective external relationships with high-level representatives of participating provider organizations and acts as the primary contact for these providers

·Develops and maintains effective relationships with cross functional teams including WellSense Legal, Compliance, Public Partnership, Network Operations, Behavioral Health Strategy, Provider Relations and all other applicable departments to advance the highest quality behavioral health network

·Participates in the development, implementation & continuous process improvement of departmental policies, procedures, workflows to support a high performing network

oOther duties and projects as assigned

Supervision Exercised:

• May supervise less experienced staff.

Supervision Received:

• General supervision is received from the Manager of Behavioral Health Network Strategy.

Qualifications:

Education:

• Bachelor’s Degree in Health Care Administration, Business, related field, or an equivalent combination of education, training and experience is required.

Experience Required:

·3 years of experience in a health insurance contracting and analytical capacity

·Advanced knowledge of behavioral health services and insurance market

·Effective internal and external presentation development and skills

·Comfortable working in a complex matrix environment

Experience Preferred/Desirable:

·Experience in an insourced Behavioral Health model

Certification or Conditions of Employment:

• Pre-employment background check

Competencies, Skills, and Attributes:

• Proficient in Power Point, Excel, and Word
• Experience with Microsoft Teams and Sharepoint

Working Conditions and Physical Effort:

·Contract Managers work out of a remote home office environment and must be able to travel to provider offices throughout Massachusetts and New Hampshire up to 50% of the time, including visiting multiple provider offices per day as needed.

·No or very little physical effort required;

·No or very limited exposure to physical risk.

·Regular and reliable attendance is an essential function of the position.

·Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.

·May be required to work additional hours beyond standard work schedule

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees