Sr. Provider Network Contract Specialist (Renton)

Sr. Provider Network Contract Specialist

Description

Responsible for the development and maintenance of the Network Plan the provider handbook, for evaluation of the adequacy of the network, for assuring that the network meets URAC and DoD standards, and that there is compliance with all elements of the TRICARE Management Activity contract.

• Understands the attitudes and values of the community and establishes effective working relationships with stakeholders to increase resources and collaboration.
• Acts as a representative and spokesperson both internally and externally.
• Responsible for assuring providers and network members are educated in Health Plan criteria and processes.
• Responsible for the non-clinical utilization management functions of the Health Plan.
• Responsible for compliance with the DoD contract regarding network and utilization issues.
• Responsible for a key role in provider contracting and network relations.

Required Qualifications :

5 years Managed care operations.

Extensive experience and understanding of capitated medicine, contracted networks and health plan contracts.

Preferred Qualifications :

Bachelor's Degree In related field.

Ambulatory medicine.

Project management.

Contract negotiation.