Contracting Specialist II - Maine: Harvard Pilgrim Health Care

SUMMARY OF POSITION
The Contracting Specialist II – Maine reports to the V.P., Maine, and is accountable for developing and executing the strategic and business plans for the Maine provider network consistent with corporate and Maine business objectives.  He/She will be responsible for developing, managing, and training all contract staff; ensuring the development and negotiation of contractual and financial arrangements with all identified providers; and establishing/maintaining a lead role for such arrangements and relationships with strategically important providers in Maine.  Additionally, he/she will be responsible for all networks filing requirements to the Maine Bureau of Insurance and developing and maintaining key relationships with appropriate BOI staff.  He/She will participate in critical external functions to further the development of HPHC in Maine and will be a key participant in the development and implementation of the Maine strategic and business plan annually.

JOB FUNCTIONS
Strategy
• Accountable for annually developing, implementing and evaluating strategic and business plans for the Maine network, including applicable unit cost containment strategies, that are consistent with corporate and Maine business objectives.
• Key contributor to the development and implementation of the Maine strategic business plan.
• Key contributor to the planning, development and implementation of a Maine marketing strategy.
• Participates on team providing monitoring activities, analysis, and response to Maine proposed legislation.
• Participates in external activities such as serving on Boards, representing HPHC.
• Takes lead role in the coordination for the planning and development of a Maine/NH cross border regional contracting strategy.
Contracting
• Accountable for ensuring the development and negotiation of contractual/financial arrangements with all Maine providers, e.g. hospital systems, integrated delivery systems, tertiary hospitals, large multi-specialty physician groups, PHOs and IPAs which support achievement of agreed upon objectives.
• Responsible for developing and negotiating risk sharing and /or other financial arrangements for complex and strategically important providers
• Ensures Harvard Pilgrim Guardrails are incorporated into contract negotiations.
• Accountable for the management of LCU performance and monitoring the impact on the Maine business plan.
• Play a key role in supporting the PCO team assessing/implementing network-wide carve-outs, sub contracts, or sub capitation arrangements.
Provider Relations
• Accountable for developing, managing, and promoting positive relationships with complex or highly aligned provider units.
• Ensures the contracting process is conducted in a manner that develops/maintains positive provider relationships.
• Ensures V.P., Maine, PRC staff and applicable senior management receive timely communication regarding significant provider issues.
• Liaison for Maine office among contracting, provider relations and PCO management.
Administrative
• Accountable for maintenance of contract negotiation calendar of renewal dates and provides the Configuration Department and other impacted departments with anticipated changes far enough in advance to support timely implementation.
• Ensures coordination/ and timely communication of contractual terms to other departments whose functions are necessary to development, implementation, and management of the provider relationships/arrangements.
• Ensures successful “testing” and sign-off of contract configuration for Maine network.
• Leads and participates as requested in project teams for HPHC.
Supervisory
• Manages, trains and directs contract staff in Maine.
• Promotes/fosters a positive relationship with team members through training, coaching, and mentoring and provides input in performance appraisal.
• Supports team performance through sharing of expertise, identifying critical issues, problem solving, and contributing to team’s strategic planning.

• Bachelor’s Degree required, Master Degree or degree in progress is preferred.
• 8-10 years of relevant health care experience and 2-3 years supervisory experience.  Some direct contracting experience is preferred.
• Demonstrates ability to understand historic payer/provider financial arrangements, to remain up-to-date with cutting edge practices and theories, (perhaps influenced by state or federal changes in law), and demonstrates the ability to convey such understandings to colleagues, customers and others. 
• Demonstrates understanding of complex, financial arrangements across health care products
• Requires strong financial and analytic problem solving skills.
• Requires excellent communication skills:  written, verbal, group presentation.
• Requires capability to work in a team environment to reach goals and objectives.
• Skill and ability to interact with key external customers, providers, employers, associations, and regulators.