Network Contract Manager Resume Sample
Caesar Hodkiewicz
5248 Jaunita Mission,
San Francisco,
CA
+1 (555) 904 2581
Work Experience
Network Contract Manager
05/2015
-
PRESENT
Detroit, MI
- Work effectively with Product team to advance the network’s strategy
- Network Contract Manager needed for growth and expansion in the Texas market development efforts (Moonshot) to include new development and current ongoing development efforts. The continued growth in Dallas / Fort Worth supports the need for additional network staff for contracting and growth
- Convey complex or technical information in a manner that others can understand, as well as demonstrate the ability to understand and interpret complex information form others
- Office or telecommuter position considered
- Work with hospital physician advocates, legal team and healthcare economics on complex and / or critical issues
- Maintain an ongoing knowledge of provider’s business; as well as their contract with OptumRx
- Research and resolve provider related contract issues
- Ensure system accuracy of responsible network contracts
Senior Network Contract Manager
03/2012
-
12/2014
San Francisco, CA
- Coordinate management of contract inventory across a team of contract managers, including ensuring contract obligations are met and provider contract data is maintained
- Collect and review provider enrollment information to determine providers’ eligibility to participate in Medicaid, through screening the providers’ credentials
- Support contract managers in validating provider data and handling system updates
- Create customized reports as needed to support contract initiatives
- Coordinate with internal matrix partners to support contract/relationship management
- Experience in a network management-related role, such as provider data management, contracting, installation, enrollment, or provider services
- Experience with accessing reports and analyzing provider data
ACO Network Contract Manager
02/2006
-
10/2011
Los Angeles, CA
- Experience and proficiency with Salesforce and FACETS
- At least an intermediate level of proficiency with MS Excel, to include use of pivot tables and filters
- Understand and streamline operations processes
- Report regularly on progress and issues
- Negotiate and implement hospital and health system contracts
- Develop and maintain excellent relationships with hospital and health system providers
- Prepare and manage all contract documents for assigned providers
- Create and deliver effective provider-specific proposals, presentations, and correspondence
- Participate in the development and execution of regional network strategy with local UHN team
Education
Vincennes University - Jasper Campus
2001 - 2006
Bachelor's Degree in Business
Professional Skills
- Excellent verbal and written communication skills; ability to speak clearly and concisely, and ability to convey complex or technical information
- Experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions
- Experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions
- Experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions
- Experience in contributing to the development of product pricing and utilizing financial modeling in making rate decisions
- Experience in contributing to the development of product pricing and utilizing financial modeling in making rate decisions
- Experience utilizing financial data in making rate decisions
How to write Network Contract Manager Resume
Network Contract Manager role is responsible for analysis, government, travel, modeling, research, reporting, contracts, training, radiology, health.
To write great resume for network contract manager job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Network Contract Manager Resume
The section contact information is important in your network contract manager resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Network Contract Manager Resume
The section work experience is an essential part of your network contract manager resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous network contract manager responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular network contract manager position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Network Contract Manager resume experience can include:
- Data analysis skills; ability to construct strategy from the provider data
- Experience utilizing financial models and analysis in negotiating rates
- Experience in developing narrow networks and meeting network adequacy guidelines
- Experience utilizing financial models and analysis in negotiating rates with physician groups and hospitals
- Experience working with Medicaid contracts
- Experience in performing network adequacy analysis
Education on a Network Contract Manager Resume
Make sure to make education a priority on your network contract manager resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your network contract manager experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Network Contract Manager Resume
When listing skills on your network contract manager resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical network contract manager skills:
- Looking for an independent go getter with a very good work ethic
- Experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions
- Experience utilizing financial models and / or financial analysis for the purpose of negotiating rates with providers or to meet other business needs
- Experience with provider contracting, including negotiations
- Experience with provider contracting, including facility, physician and ancillary
- Experience in performing network adequacy analysis
List of Typical Experience For a Network Contract Manager Resume
1
Experience For Senior Network Contract Manager Resume
- Effectively interact and collaborate with designated individuals for each line of business and matrix partners
- Experience in a network management related role, such as contracting or provider services
- Experience with functions of provider data maintenance, contract installation, enrollment, and credentialing
- Experience in a network management - related role, such as contracting or provider services
- Experience in a network management-related role, such as contracting or provider services
- Physician group & hospital or health system negotiation experience and oversight management of provider groups
2
Experience For Healthcare Provider Network Contract Manager Resume
- Demonstrate ability to work collaboratively internally/externally on cross functional teams to accomplish tasks
- Experience in a network management - related role, such as contracting or provider services
- Experience in a network management related role, such as contracting or provider services
- Experience in a network management-related role, such as contracting or provider services
- Experience in fee schedule development
3
Experience For ACO Network Contract Manager Resume
- Experience in Medicaid/Medicare and Long Term Care and Home and Community Based Providers
- Experience in a network management - related role, such as contracting or provider services
- Experience with fee schedule development
- Previous experience with facility and/or complex health systems
- Experience in capitation rate development
- Previous hospital contract negotiation experience
- Experience with strategic discussions with internal and external c-suite level roles
4
Experience For Physician Network Contract Manager Resume
- Self –starter, detailed oriented individual eager to continually develop their skill set
- Previous Leadership/managerial experience
- Previous experience with FQHC / RHC
- Able to build and maintain strong relationships with internal and external contacts
- Experience in Medicaid / Medicare and Long Term Care and Home and Community Based Providers
- Previous experience with Providers in Washington state
5
Experience For Network Contract Manager Orlando Resume
- Experience in the health care
- Experience at the hospital level
- Reporting to the Director of Network Contracting
- Collaborate with other departments within UHC to achieve favorable outcomes (finance, pricing, legal…etc.)
- Hospital, Ambulatory Surgery Centers and other Ancillary contracting primarily in the Georgia or Carolina markets
- Provider education and training to provider network
- Quickly learn new applications and systems with training
6
Experience For Senior Hospital Network Contract Manager Resume
- Understand and interpret complex information form others, including but not limited to reimbursement policy standards
- Monitor and analyze financial and quality metrics to assess network performance
- Assess and interpret provider/member needs and requirements
- Present complex materials to executives, perform solid financial analysis, use of data bases in an effective manner, manage projects to deliver timely
- Capitation experience and oversight management of provider groups
- Provide consistency in applied practices to drive long-term change
- Individual needs to be a self - started
- Work well as a team
7
Experience For Non-par Network Contract Manager Resume
- An appropriate distribution of provider specialties
- Provide explanations and information to others on difficult issue
- Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance, trend management and appropriate distribution of provider specialties
- Work with minimal guidance or be an independent contributor; be able to demonstrate sound decision making or the need to seek guidance on only the most complex tasks
- As the owner of the relationship, act as the primary contact for the hospital and be the face of UnitedHealthcare to that provider
- Negotiate and prepare facility agreements that are geographically competitive
- Achieve objectives for unit cost performance and trend management
- Prepare and negotiate value-based, performance-based, and creative contracts for assigned regional facilities
8
Experience For Senior Healthcare Provider Network Contract Manager Resume
- Collaborates with Provider Network team to ensure that network composition includes an appropriate distribution of provider specialties
- Participate in regional and state-based contracting and/or provider network calls; Possess a willingness and ability to provide explanations and information to others on difficult and/or complex contracting issues (i.e. subject matter expert)
- Building and maintaining key provider relationships
- Guide development of geographically competitive, broad access, stable network that achieve objectives for unit cost performance and trend management
- Develop/Negotiate/Support Terms of Agreement with Vendors
9
Experience For Hospital Network Contract Manager Resume
- Evaluate current contract performance to identify potential remediation opportunities and/or cost savings
- Communicate contractual and/or operational performance to identify opportunities to improve performance and/or vendor relationship
- Seek information from relevant sources (e.g. Publications, government agencies, trade associations) to understand market intelligence information
- Serve as Vendor Relationship Owner (VRO)
- Evaluate and negotiate physician and hospital contracts in compliance with company templates, reimbursement structure standards, and other key process controls
- Provide explanations and information to others on difficult issues as the owner of the relationship, act as the primary contact for the hospital and be the face of UnitedHealthcare to that provider
- Develop detailed, and concise strategy and plans to yield desired outcome of the organization across multiple lines of business
10
Experience For Hospital & Physician Network Contract Manager Resume
- Independently develop contract negotiation strategies to meet all business objectives for Commercial, Medicare and Medi-Cal Lines of Business
- Lead contract negotiations on all hospitals and medical groups for all assigned San Diego providers
- Cultivate relationships and partnerships with assigned providers in San Diego
- Serve as the primary point of contact for any contract related matters
- Willingness to assist and mentor others on the team
- Oversee contract implementation for all lines of business
- Motivate and inspire other team member
List of Typical Skills For a Network Contract Manager Resume
1
Skills For Senior Network Contract Manager Resume
- Experience serving in a network management-related role, such as contracting or provider services
- Experience utilizing financial models and analysis in negotiating rates with providers
- Demonstrate understanding of contract policies & procedures to ensure compliance and consistent contracting across the enterprise
- Experience in a network management-related role, such as contracting or provider services
- Experience working with Medicaid
- Experience in a network management-related role, such as contracting or network development; preferably with large facilities or providers
- Experience with provider contracting
2
Skills For Healthcare Provider Network Contract Manager Resume
- Experience in a network management related role, such as contracting or provider services
- Experience in fee schedule development using actuarial models
- Experience in a network management - related role handling complex network providers with accountability for business result
- Experience in a network management - related role, such as contracting or provider services
- Previous experience with contracting at the hospital or facility level
- Experience with provider contracting
3
Skills For ACO Network Contract Manager Resume
- Experience in a network management or healthcare-related role, such as contracting or provider services
- Experience utilizing financial models and analysis
- Experience in a network management related role, such as contracting or provider services
- Experience in a network management-related role handling complex network providers with accountability for business results
- Experience in a network management related role handling complex network providers with accountability for business results
- Experience in meeting network adequacy guidelines
- Experience working with relationships across all business levels but not sales oriented
- Experience using financial models and analysis to negotiate rates with provider
4
Skills For Physician Network Contract Manager Resume
- Experience using financial models and analysis to negotiate rates with providers
- Experience in performing network analysis/research
- Experience in provider contracting related role or network management and provider services
- Experience in a network management-related role, such as contracting or provider service
- Previous reporting and analysis experience
- Experience in a network management-related role, such as contracting and provider services
- Experience working with Capitation reimbursement methodologies
5
Skills For Network Contract Manager Orlando Resume
- Experience working with Fee for Service reimbursement methodologies
- Experience in a network management-related role handling complex network providers with accountability for business results
- Experience negotiating rates with providers
- Experience in a network management-related role, such as contracting or provider services with Arizona Long Term Care Services (ALTCS)
- Hospital contracting experience
- Experience working with large health systems on negotiations for contractual relationships
- Experience in a network management-related role, including provider services
- Experience in performing network analysis
- Experience negotiating facility and/or physician rates with providers
6
Skills For Senior Hospital Network Contract Manager Resume
- Demonstrate understanding and ability to execute Quality Management program
- Experience with contract implementation
- Experience in a network management-related role
- Experience with provider contracting
- Experience in a network management-related role handling complex network providers with accountability for business results
- Experience in the health care industry
- Experience with Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS)
- Experience in fee schedule development
7
Skills For Non-par Network Contract Manager Resume
- Previous experience in performing network adequacy analysis
- Experience in a Network related role
- Experience in fee schedule development
- Experience within NDB, COSMOs, and Facets
- Experience with government programs (Medicare / Medicaid)
- VRO (Vendor Relationship Owner) or comparable experience (External Resource Mgmt.)
- Previous Supervisory/Management experience
- Previous contract management experience
- Self - starter, detailed oriented individual eager to continually develop their skill set
8
Skills For Senior Healthcare Provider Network Contract Manager Resume
- Direct negotiation experience with network providers
- Experience in fee schedule development
- Experience with OneNote, PowerPoint
- Experience with MSO's, ACO's, HEDIS, STARs, Capitations, Delegation, Fee-for-Service, and Medicare
- Experience in a network management-related role, such as contracting or provider services
- Experience with capitation
- PBM or Pharmacy experience
9
Skills For Hospital Network Contract Manager Resume
- Negotiation experience specifically with hospitals and medical groups
- Experience with FQHC and RHC Physicians
- Reporting to a Director of Network Contracting
- Understanding of Accountable Care Organizations and CPC+ programs
- Drive business planning which includes coordinating work among multiple teams, and owning end-to-end contracting process
10
Skills For Hospital & Physician Network Contract Manager Resume
- Manage unit cost budgets, target setting, performance reporting and associated financial models relative to ancillary and FQHC contracting
- Manage unit cost budgets, target setting, score carding, performance reporting and associated financial models
- In-depth knowledge of fee-for-service (FFS), risk sharing, and value-based or “creative” contracting
- Travel 50% of the time to provider locations in California and surrounding states
- Demonstrable knowledge of managed care contracting concepts, provider network access, and CMS and Medicaid rules
- Comfort level in delivering network management related discussions externally
- Working with Medicare Resource Based Relative Value System (RBRVS)
- Knowledge and understanding of Medicare and Medicaid methodologies
- In-depth knowledge of network provider contracting and different hospital payment methodologies
List of Typical Responsibilities For a Network Contract Manager Resume
1
Responsibilities For Senior Network Contract Manager Resume
- Demonstrate understanding of applicable products for different lines of business (e.g., Employer and Individual; Medicare and Retirement; Community and State)
- Demonstrate understanding of contract language in order to assess financial and operational impact and legal implications of requested contract changes
- Experience in physician group & hospital rate development
- Travel 80% and overnight stay when expanding new markets
- In depth knowledge of Medicaid State Fee for Service billing practices
- Ensure that network composition includes an appropriate distribution of provider ancillary and FQHC specialties
- Led, supervise and / or mentor employees
- Get ready for some significant challenge
- Participate in provider meetings, trainings
2
Responsibilities For Healthcare Provider Network Contract Manager Resume
- Act as network liaison to client health plans with onsite presence as needed
- Evaluate and negotiate large specialty contracts, reimbursement structure standards and other key process controls
- Forecast contract impacts to clients and PBM
- Develop and manage competitive network programs that achieve objectives for performance and adheres to regulatory requirements, trend management and appropriate distribution of providers while managing client expectations
- Understand and recommend deviations from standard contract language and rates
- Understand and authorize deviations from contract standards when required
- Get ready for some significant challenge. This is an intense, fast-paced environment that can be demanding. In addition there are some data challenges and unique problems that need to be solved related to gaps in the process
- Demonstrate understanding of and utilize applicable financial tools (e.g., HPM; PPM; FAT; HCE's RVU/Unit tool) and reports (e.g., internal financial models; external reports) to evaluate performance of current contracts
- Balance financial and operational impact of contracts to providers, members, UHN, and different customer groups when developing and/or negotiating contract terms
3
Responsibilities For ACO Network Contract Manager Resume
- Interact and consult with Network Pricing team to evaluate different financial arrangements and to identify and recommend applicable payment methodologies (e.g., FFS; Case Rate; Sub-capitation; Pay for Performance) in order to maximize value for Stakeholders
- Identify and share best practices (e.g., payment methodologies; negotiation tactics) with national and regional colleagues
- Represent department in internal meetings to gather relevant information, present/recommend solutions, and provide updates on results/decision/activities
- Evaluate, negotiate, and manage implementation of contracts in compliance with company templates, reimbursement structure standards and other key process controls
- Manage unit cost budgets, target setting, performance reporting and associated financial model
- Knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc
- In-depth knowledge of Medicare reimbursement methodologies
4
Responsibilities For Physician Network Contract Manager Resume
- Knowledge of HEDIS and Risk Adjustment
- Strong level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc
- Location is Columbia, Maryland. This is an office based position
- Travel regionally up to about 10% of the time
- In the managed care industry
- Knowledge of Medicaid and Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS)
- Emptoris (Contract system), Nice, NDB, VPN
5
Responsibilities For Network Contract Manager Orlando Resume
- Travel ~ 50% to provider locations in Pennsylvania, New Jersey and New York
- Speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others
- Experience in a network management-related role, such as contracting and negotiating services with complex Healthcare Providers
- Travel ~ 50% to provider locations in Florida / Southern Georgia
- Travel ~ 50% to provider locations in Alabama / Northern Georgia
- Advanced level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc
- Experience utilizing financial models and /or financial analysis for the purpose of negotiating rates with providers or to meet other business needs
6
Responsibilities For Senior Hospital Network Contract Manager Resume
- At least two years’ experience contracting Home and Community Based Services (HCBS) provider types to support Managed Long Term Supports & Services (MLTSS) programs
- Experience in ACO contracting/concepts
- Intermediate level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Centers, etc
- Experience utilizing financial models and / or financial analysis for the purpose of negotiating rates with providers or to meet other business needs
- In - depth knowledge of Medicaid reimbursement methodologies
- Experience in performing network adequacy analysis Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others
7
Responsibilities For Non-par Network Contract Manager Resume
- In-depth knowledge of Medicaid reimbursement methodologies
- Intermediate level of knowledge of Medicare and Commercial reimbursement methodologies
- Knowledge of Value Based payment models such as ACO and Risk Based Payment Models
- Intermediate level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surger Center Groupers, etc
- In-depth knowledge of capitation reimbursement methodologies and delegated claims with utilization management (UM)
- At least an intermediate knowledge of Medicare reimbursement methodologies, i.e. Resource Based Relative Value System (RBRVS)
- Intermediate or higher proficiency in Microsoft Excel
- Travel ~ 50% to provider locations in the Southeastern US (LA, MS, AL, GA, FL, TN)
- Familiarity with the Medicare Stars Program
8
Responsibilities For Senior Healthcare Provider Network Contract Manager Resume
- Location is Atlanta, GA.- Market covered is state of GA
- Location is Miramar, FL.- Market covered is state of FL
- Knowledge of Medicare and / or Medicaid reimbursement methodologies
- Live within the vicinity of San Francisco and Sacramento, CA
- Experience in a network management-related role, such as contracting or provider services, handling complex network providers with accountability for business results
- Knowledge of Medicare Resource Based Relative Value System (RBRVS) and DRG Methodologies
- Intermediate proficiency in MS Office (Word, Excel, and PowerPoint)
9
Responsibilities For Hospital Network Contract Manager Resume
- Experience in a network management-related role, such as contract negotiation roles with hospitals & physician groups or manager of provider services
- In-depth knowledge of physician & hospital reimbursement methodologies and contract language
- Expectations to build trusted relationships with providers in Southern IL and Northern IL markets by conducting face to face meetings 2 to 3 days a week including applicable travel
- In-depth knowledge of various provider reimbursement methodologies
- Familiarity with the Orlando and/or Jacksonville Provider Community
- Familiarity with the Pennsylvania Provider Community
- Intermediate level of proficiency with MS Office (Word, Excel, PowerPoint, Outlook
10
Responsibilities For Hospital & Physician Network Contract Manager Resume
- Access to reliable transportation and ability to travel 50%
- Knowledge of Medicare Resource Based Relative Value System (RBRVS)
- In-depth knowledge of physician fee schedule methodologies
- Currently reside in the state Idaho
- Familiarity with the upstate NY Provider Community
- In-depth knowledge of ancillary and physician reimbursement methodologies
- Familiarity with Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), MS-DRGs, Ambulatory Surgery Center Groupers, etc
- Advanced level of knowledge of Medicare Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc
- Familiarity with the New Jersey Provider Community
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