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.

The Ancillary Contract Manager is responsible for the development, implementation and management of a cost-effective provider network, maintaining complex and geographically diverse contracts. Serves as a mentor to Regional Contract Manager, assisting in the development of network-wide strategies to improve efficiencies and access.  Under the direction of the Director of Provider Contracting, s/he 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: 

• Interprets environmental (policy, contract, landscape, organizational) changes with contracting and provider impact.  Guides internal response strategies
• Gathers and analyzes data and other relevant intelligence in assessing provider network adequacy against required standards and business expectations
• Identifies, assesses and develops strategies for improving provider and network cost, utilization and quality performance
• Leads negotiations of financial and other contractual terms, including risk sharing terms
• Ensures all contract terms and conditions comply with financial and legal requirements of the company and its regulatory entities (e.g., MassHealth, MA Division of Insurance, EOHHS)
• Develops and maintains business relationships with high-level representatives of key contracting hospitals, physicians and ancillary service providers
• Participates in the development, implementation & continuous improvement of departmental policies, procedures, workflows, and tools as they relate to network development and provider contracting
• Represents the department and organization supporting internal and external initiatives
• Performs other duties as required to accomplish departmental and corporate goals & objectives
• May supervise less experienced staff

COMPETENCIES, SKILLS, AND ATTRIBUTES: 

• 5-10 years experience, some in senior position.  Medicaid managed care experience preferred
• Interpersonal and leadership style necessary to serve as ‘go-to’ resource for colleagues
• Proven analytical skill in assessing and projecting financial, utilization and quality performance on an individual provider and network basis
• In-depth knowledge and understanding of contract finance and provider reimbursement methodologies, including risk, shared savings, pay-for-performance and other financial incentive strategies
• In-depth knowledge and understanding of current healthcare industry issues and trends, including national and state-level payment reform landscape and strategy (e.g., accountable care and patient centered medical home); especially including but not limited to: SNF, VNA, Rehab and LTAC
• Proven negotiation skills with hospitals, Integrated Delivery Networks, physicians and ancillary service providers
• Proven skill in critical thinking and strategic planning and implementation
• Knowledge of federal and state Medicare, Medicaid, and relevant guidelines, regulations and standards
• Effective communication (verbal and written) and relationship building skills. Position will interact with internal and external executive teams
• Expertise in Microsoft Office programs and industry-standard financial applications as appropriate

WORKING CONDITIONS AND PHYSICAL EFFORT: 

• Work is normally performed remotely with some travel to providers and office

ABOUT WELLSENSE

WellSense Health Plan is a nonprofit health insurance company serving more than 440,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

*WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.

Required Skills Required Experience