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The Network Contractor develops the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners. Network Contractors evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties.
- Use pertinent data and facts to identify and solve a range of problems within area of expertise
- Investigate non-standard requests and problems, with some assistance from others
- Work exclusively within a specific knowledge area
- Prioritize and organize own work to meet deadlines
- Provide explanations and information to others on topics within area of expertise
- Responsible for physician contract negotiations within assigned territory