Contract Manager – Vendor Performance NC Medicaid – Remote Job 2024 Full Time

Contract Manager – Vendor Performance NC Medicaid – Remote

Responsible for the implementation and support of all activities related to developing and maintaining service provider contracts. Interacts with all areas of the Prime Therapeutics organization to coordinate network management and network administration responsibilities and facilitates resolution of contract issues, obtains legal review and approval of working changes in contract documents. This position is responsible for monitoring provider contract compliance and for development of performance-based contract incentives.

• Responsible for Contract/Vendor Performance.
• Serves as the point-person for all Contract management, Vendor performance management, and escalations. Provides MES Vendor Performance and SLA support to DHHS as defined throughout the Contract.
• Negotiates contracts and amendments with Public Network Operators (PNOs), Qualified Service Providers (QSPs), facilities, organizational and/or large group providers, as well as independent practitioners.
• Works with other departments as needed for timely completion of annual amendment cycles from beginning to end.
• Manages annual re-contracting efforts across departments.
• Provides oversight to the Prospective Provider and SCA processes.
• Manages the Primary Care Management Module (PCMM) and Rates Governance process to address provider requests for contract modification.
• Minimizes situations where retro-active contract modifications are required.
• When retro-active implementation is necessary, utilizes streamlined approach to obtain approvals, providing thorough communication to approvers regarding the reason for delay.
• Monitors ongoing provider performance changes in cost and utilization needs.
• Develops and maintains professional working relationships with providers.
• Analyzes contract modification requests and coordinates with the Finance Department on financial impact of any rate/funding changes.
• Develops and implements process for monitoring provider contract compliance and performance based contract incentives.
• Identifies and implements process improvements to the contract/amendment process as needed.
• Ensures that contracts are system compatible, loaded correctly, timely and meet legal and business standards.
• Ensures contracts audits are accurate and on time.
• Develops and maintains professional working relationship with providers.
• Provides supervision/performance management to team of contract coordinators.
• Works in concert with other teams to respond to changing or emerging system initiatives; actively participates in RFP re-bid processes as needed.

• Related professional experience in the managed care, healthcare, or insurance industries.
• Analytical/problem solving skills.
• Excellent verbal and written communication skills.
• Strong PC background and efficient in using standard software.
• Knowledge of system process analysis and/or program management, estimating IT system development, and testing.
• For positions supporting Medicare, requires experience working in Medicare Operations.

Contract Administration and Management, Network

A Combination of Education and Work Experience May Be Considered., Bachelors

Potential pay for this position ranges from $66,880.00 – $107,000.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.