Provider Contract Manager II

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Provider Contract Manager II performs intermediate‑level contracting, analysis, and provider relationship responsibilities that support building a competitive, compliant, and cost‑effective network. This role evaluates network adequacy, conducts routine provider negotiations, and manages contracting workflows with moderate independence. It collaborates across business areas to ensure contracts align with reimbursement standards, regulatory requirements, and operational needs. As a developing professional, the Contract Manager II handles moderately complex contracting assignments and contributes meaningfully to network performance and provider engagement.

Develop and maintain provider networks yielding a competitive, geographic, stable network that achieves objectives for unit cost performance and trend management. Produces an affordable and predictable network for customers and business partners. Evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Establishes and maintains strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties. Performs other duties as assigned.

Key Accountabilities

• Support Network Optimization
• Evaluate market dynamics and provider availability to support a competitive, geographically adequate network.
• Partner with internal teams to ensure network configuration supports product and regulatory requirements.

Manage Routine Provider Contract Negotiations & Updates

• Review proposed terms, reimbursement structures, and negotiation considerations in alignment with company standards.
• Conduct negotiations with physicians, ancillary providers, and smaller facilities to reach compliant agreements.
• Ensure contracts follow approved templates, legal requirements, and documentation standards.
• Analyze financial impacts of proposed terms and escalate exceptions as needed.

Maintain Provider Relationships & Support Provider Engagement

• Serve as the primary point of contact for routine contract questions and manage provider relationship and escalations.
• Communicate performance metrics, contract requirements, and network initiatives effectively.
• Support provider understanding of reimbursement methodologies, operational workflows, and administrative processes.
• Attend provider meetings or workgroups to build positive, collaborative relationships.
  
  
• Perform Data Analysis & Develop Market Insights
• Analyze claims, cost, and utilization data to detect patterns affecting contracting decisions.
• Use market intel and benchmarking to support negotiation strategy development.
• Utilize and edit models to prepare summaries or recommendations for internal review.
• Track competitor activity and regulatory updates that may impact network structure.

Support Process Improvement & Cross-Functional Collaboration

• Suggest enhancements to contracting workflows, tools, or documentation processes.
• Collaborate with legal, finance, provider operations, and clinical teams to implement contracts smoothly.
• Participate in initiatives such as value‑based contracting, quality programs, or cost‑of‑care efforts.
• Share knowledge and best practices with peers to strengthen team capabilities and consistency.

Required Qualifications

• Bachelor's degree or equivalent experience in related field
• 3+ years of work experience beyond degree in contract negotiations and healthcare
• WI market knowledge within provider contracting

Skills and Abilities

• History of Basic Health plan operations and/or provider operations experience
• Excellent communication (written, verbal and presentation) skills
• Ability to work independently, make sound judgment calls and determine when things should be escalated
• Proven track record of cultivating and maintaining effective, collaborative external relationships where the parties trust information that’s conveyed
• Proven track record as a successful contract negotiator for health care services, provider or health plan
• Flexibility and creativity in developing effective contracting terms
• Knowledge of provider contracting components and strategies such as but not limited to risk-based contracting, financial models, operational impact and data analytics
• Demonstrated understanding of complex financial arrangements and quality programs across health care products
• Strong financial, analytical and problem-solving skills, and understanding of legal documents
• Strategic-thinking skills with the ability to conceptualize a wide range of scenarios and the ability to analyze each scenario to come up with the most viable option

This position is a Remote role. To be eligible for consideration, candidates must have a primary home address located within any state where Medica is registered as an employer - AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI

The full salary grade for this position is $70,200 - $120,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $70,200 - $120,400. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.