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 Regional Contract Manager facilitates development; implementation and management of cost-effective provider networks in his/her assigned geographic region(s). Under the direction of the Manager of Contracting, he/she 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:

• 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 in all lines of business
• Ensures all contract terms and conditions comply with financial and legal requirements of our company and its regulatory entities (e.g., MassHealth, Commonwealth Connector)
• 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
• Performs other duties as required to accomplish departmental and corporate goals & objectives
• May supervise less experienced staff

Qualifications:

Education:

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

Experience:

• 3 years of progressive experience in a contracting and analytical capacity in a leadership role is required for individuals with a baccalaureate degree, four years experience is required for individuals without a baccalaureate degree

Competencies, Skills, and Attributes:

• 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)
• 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
• Expertise in Microsoft Office programs and industry-standard financial applications as appropriate

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.