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Job Posting Title

Contract Manager - NC Medicaid

Job Description Summary

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.

Job Description

• 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 this book of business.

• 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.

Requires at least 10 years of experience managing large service and contracts. Significant experience with stakeholder engagement and focused on customer experience.

Responsibilities

• For roles supporting MRx, a Pharmacy Technician (either CPT/LPT/PTCB/RPT based on State Requirements) preferred.

• Demonstrated proficiency of pharmacy data and information.

• Project management experience.

• Strong preference for managed care contracting experience.

• A minimum of 5 years of progressively more responsible public sector health care administration experience in contract administration.

• Demonstrated advanced experience with public sector financial/contractual analysis and negotiations including risk arrangements.

• Awareness of and/or experience with trends toward contracting integrated healthcare networks.

• Critical thinker.

• Self-motivated and a team player.

• 5 years of direct experience in lieu of degree.

Work Experience

Work Experience - Required:

Contract Administration and Management, Network

Work Experience - Preferred:

Education

Education - Required:

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

Education - Preferred:

Certifications

Certifications - Required:

Certifications - Preferred:

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.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer and a Tobacco-free workplace . We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures .

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. ​ If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.