South Country Health Alliance
Associate Director of Provider Network and Contracting
South Country Health Alliance, Medford, Minnesota, United States, 55049
Associate Director of Provider Network and Contracting
South Country Health Alliance is seeking an Associate Director of Provider Network and Contracting to provide operational direction and leadership to the Provider Contracting and Provider Relations teams. The role will secure and maintain competitive contractual relationships with providers in accordance with regulatory, operational, and financial goals and standards, and ensure South Country’s adherence with network management goals, state, federal and other regulatory requirements.
Job Summary This position is responsible for providing operational direction and leadership to South Country’s Provider Contracting and Provider Relations teams to secure and maintain competitive contractual relationships with providers in accordance with regulatory, operational, and financial goals and standards, and ensure South Country’s adherence with network management goals, state, federal and other regulatory requirements.
What You’ll Bring
Bachelor’s degree in Health Care Administration or a business-related field.
5+ years of experience in a health care delivery setting.
3+ years of experience in contract and pricing management in health care.
Knowledge of both State Public Programs (MN Medicaid) and Medicare (dual) products.
Direct contracting and negotiation experience with providers.
Why South Country? South Country Health Alliance is more than a health plan – we’re a mission-driven organization dedicated to improving health and well‑being in rural Minnesota communities. Our work is guided by values of communication, collaboration, stewardship, and excellence, ensuring that every employee contributes to making a real difference in people’s lives. https://mnscha.org
We Invest In Our Team With
Comprehensive benefits: Medical, dental, vision, life insurance, short- and long-term disability, pension (PERA), and more.
Work‑life flexibility: Hybrid and remote options with quarterly on‑site expectations.
Predictable pay growth: Structured step-based salary system for transparency and stability. The salary range for this position is between $117,000 and $139,713 per year.
Qualifications Required
Bachelor’s degree in a health care or business-related field or other relevant field.
Five years of experience in a health care delivery setting.
Three years of experience in contract and pricing management in health care.
Knowledge of both State Public Programs (MN Medicaid) and Medicare (dual) products.
Direct contracting and negotiation experience with providers.
Preferred
Knowledge of and experience with provider credentialing and related processes.
Skill Sets Outstanding oral, written, and interpersonal communication skills; demonstrated leadership ability; exceptional conflict and problem resolution skills; strong organization skills; proficient in providing high-level customer service; strong financial analysis skills and ability to analyze data and processes and apply them to network development and contracting; self‑starter and ability to take initiative; excellent presentation skills; well-developed project management and negotiation skills.
ESSENTIAL DUTIES And RESPONSIBILITIES
Coach, mentor, and manage a team of professionals to achieve favorable and timely contract terms, build and strengthen relationships with key providers, and support South Country’s strategic provider-related goals. (20%)
Lead, develop and implement South Country’s provider network contracting activities, and respond to access and availability enhancement goals. Bring provider market intelligence and insights to key internal provider forums to inform direction and decisions. (20%)
Along with the Compliance Officer and the CFO, negotiate contractual relationships with providers that support SCHA’s strategic, financial, operational, and program-specific goals, utilizing an appropriate reimbursement methodology consistent with network strategy and contracting goals. Ability to work with outside consulting actuaries on structure and financial modeling of programs. (20%)
Develop an annual contract renewal and negotiation plan in collaboration with teams and other internal stakeholders. Report status quarterly to South Country leadership and key committees. (10%)
Maintain a working knowledge of State of MN and CMS provider reimbursement methodologies and other relevant strategies and ensure this information is presented to South Country operational areas as may be relevant to support South Country’s policies and strategies. (10%)
Develop and maintain network oversight plans by provider/network type. Ensure contractual, regulatory and NCQA compliance for network providers. (10%)
Support program management efforts related to unique Medicare and Medicaid networks. Ensure departmental staff members align work efforts with enterprise-wide goals and objectives for these networks/services. (5%)
Work effectively with South Country’s Compliance Officer, CFO, leadership, program managers, operations staff and selected third party administrators to ensure that the South Country provider contracts are understood and interpreted (for system implementation) for accurate administration. (5%)
Other duties assigned within the scope, responsibility and requirements of the job.
Additional Information Must be legally authorized to work in the U.S. (No sponsorship available). Must be able and willing to travel regionally as support of job responsibilities.
Department: Provider Network and Contracting
Reports To: Compliance Officer
Pay Grade: 14
Supervises: 4
Revision Date: December 2025
Seniority level Director
Employment type Full-time
Job function Strategy/Planning and Information Technology
Industries Hospitals and Health Care
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Job Summary This position is responsible for providing operational direction and leadership to South Country’s Provider Contracting and Provider Relations teams to secure and maintain competitive contractual relationships with providers in accordance with regulatory, operational, and financial goals and standards, and ensure South Country’s adherence with network management goals, state, federal and other regulatory requirements.
What You’ll Bring
Bachelor’s degree in Health Care Administration or a business-related field.
5+ years of experience in a health care delivery setting.
3+ years of experience in contract and pricing management in health care.
Knowledge of both State Public Programs (MN Medicaid) and Medicare (dual) products.
Direct contracting and negotiation experience with providers.
Why South Country? South Country Health Alliance is more than a health plan – we’re a mission-driven organization dedicated to improving health and well‑being in rural Minnesota communities. Our work is guided by values of communication, collaboration, stewardship, and excellence, ensuring that every employee contributes to making a real difference in people’s lives. https://mnscha.org
We Invest In Our Team With
Comprehensive benefits: Medical, dental, vision, life insurance, short- and long-term disability, pension (PERA), and more.
Work‑life flexibility: Hybrid and remote options with quarterly on‑site expectations.
Predictable pay growth: Structured step-based salary system for transparency and stability. The salary range for this position is between $117,000 and $139,713 per year.
Qualifications Required
Bachelor’s degree in a health care or business-related field or other relevant field.
Five years of experience in a health care delivery setting.
Three years of experience in contract and pricing management in health care.
Knowledge of both State Public Programs (MN Medicaid) and Medicare (dual) products.
Direct contracting and negotiation experience with providers.
Preferred
Knowledge of and experience with provider credentialing and related processes.
Skill Sets Outstanding oral, written, and interpersonal communication skills; demonstrated leadership ability; exceptional conflict and problem resolution skills; strong organization skills; proficient in providing high-level customer service; strong financial analysis skills and ability to analyze data and processes and apply them to network development and contracting; self‑starter and ability to take initiative; excellent presentation skills; well-developed project management and negotiation skills.
ESSENTIAL DUTIES And RESPONSIBILITIES
Coach, mentor, and manage a team of professionals to achieve favorable and timely contract terms, build and strengthen relationships with key providers, and support South Country’s strategic provider-related goals. (20%)
Lead, develop and implement South Country’s provider network contracting activities, and respond to access and availability enhancement goals. Bring provider market intelligence and insights to key internal provider forums to inform direction and decisions. (20%)
Along with the Compliance Officer and the CFO, negotiate contractual relationships with providers that support SCHA’s strategic, financial, operational, and program-specific goals, utilizing an appropriate reimbursement methodology consistent with network strategy and contracting goals. Ability to work with outside consulting actuaries on structure and financial modeling of programs. (20%)
Develop an annual contract renewal and negotiation plan in collaboration with teams and other internal stakeholders. Report status quarterly to South Country leadership and key committees. (10%)
Maintain a working knowledge of State of MN and CMS provider reimbursement methodologies and other relevant strategies and ensure this information is presented to South Country operational areas as may be relevant to support South Country’s policies and strategies. (10%)
Develop and maintain network oversight plans by provider/network type. Ensure contractual, regulatory and NCQA compliance for network providers. (10%)
Support program management efforts related to unique Medicare and Medicaid networks. Ensure departmental staff members align work efforts with enterprise-wide goals and objectives for these networks/services. (5%)
Work effectively with South Country’s Compliance Officer, CFO, leadership, program managers, operations staff and selected third party administrators to ensure that the South Country provider contracts are understood and interpreted (for system implementation) for accurate administration. (5%)
Other duties assigned within the scope, responsibility and requirements of the job.
Additional Information Must be legally authorized to work in the U.S. (No sponsorship available). Must be able and willing to travel regionally as support of job responsibilities.
Department: Provider Network and Contracting
Reports To: Compliance Officer
Pay Grade: 14
Supervises: 4
Revision Date: December 2025
Seniority level Director
Employment type Full-time
Job function Strategy/Planning and Information Technology
Industries Hospitals and Health Care
#J-18808-Ljbffr