Job Description

Job Description

The Sr. Manager, Provider Contracting is responsible for contracting with all provider types and successful provider network performance related to key financial, operational, and member satisfaction performance indicators in a multi-market territory. Works closely with Network Management and other departments to enhance the contracted provider experience consistent with company’s mission statement and values.

Location: El Paso, San Antonio TX

General Duties & Responsibilities

In this role, you will play a key leadership part in expanding and strengthening our provider network. Your responsibilities will include, but are not limited to:

Network Strategy & Contracting

• Partner with Network Management leadership to develop and execute market-specific contracting strategies.
• Recruit and onboard providers to eliminate network gaps and support regional growth.
• Negotiate, renegotiate, and finalize contracts with primary care providers, specialists, hospitals, ancillary providers, and groups/IPAs.
• Ensure accurate contract setup and administration across all agreements.

Team Leadership & Operational Excellence

• Lead, mentor, and coach staff to support performance, skill development, and career growth.
• Oversee day-to-day network operations to ensure compliance with company standards.
• Develop provider education materials to support adherence to company requirements.

Provider Engagement & Performance Management

• Create agendas and lead Joint Operations Meetings focused on performance improvement, operational issue resolution, and provider support.
• Oversee New Provider Orientations and Contract Orientation sessions.
• Address issues related to utilization management, financial performance, enrollment, appeals and grievances, provider terminations, continuity of care, and marketing activities.

Data Reporting & Workplan Execution

• Execute regional workplans by monitoring performance metrics, updating progress, and communicating results internally and externally.
• Ensure accurate and timely reporting on eligibility, capitation, network contacts, risk sharing, claims timeliness, utilization data, encounter submissions, and audit compliance.
• Align goals and objectives with Network Management leadership to meet departmental KPIs and support organizational growth.

Issue Resolution & Compliance

• Apply contracting expertise to research and resolve complex issues involving shared risk pools, claims, appeals, and eligibility.
• Respond professionally and promptly to provider and member grievances.
• Develop and implement departmental policies and procedures; interpret company policies as needed.

Cross-Functional Collaboration

• Represent the department in interdepartmental meetings and on designated committees.
• Support additional initiatives and projects as assigned.

Supervisory Responsibilities

You will oversee assigned staff and may manage third-party vendors or student workers. Responsibilities include:

• Recruiting, selecting, onboarding, and training employees
• Assigning workload and monitoring performance
• Conducting evaluations and providing ongoing coaching
• Addressing performance issues and maintaining a supportive, accountable team environment

Minimum Requirements

Experience

• 5–7 years of experience in an HMO, managed care organization, IPA/Medical Group, institutional provider, or health insurance company.
• At least 5 years of direct experience in managed care contracting, including strong knowledge of Medicare Advantage regulations .
• Prior supervisory or team leadership experience required.

Education

• Bachelor’s degree or equivalent work experience required.

Technical & Professional Skills

• Proficiency in MS Office with strong skills in Word and Excel.
• High attention to detail and accuracy.
• Ability to read, interpret, and apply contracts, operational manuals, and regulatory guidance.
• Strong written and verbal communication skills, including the ability to present to providers and internal teams.
• Ability to calculate fee schedules, per diem rates, discounts, commissions, percentages, and other financial metrics.
• Strong analytical, reasoning, and problem-solving capabilities.
• Ability to synthesize and apply complex information to real-world situations.

Other Requirements

• Reliable transportation; valid driver’s license and auto insurance if driving.
• Ability to work extended hours when needed.
• Travel to provider sites approximately 20–40% of the time.

Work Environment

You will encounter typical office and field-based conditions. Reasonable accommodations can be made for individuals with disabilities.

Essential Physical Functions

The physical demands for this position include:

• Regular speaking and listening
• Frequent standing, walking, sitting, and manual dexterity for handling documents and tools
• Occasional lifting/moving of up to 10 pounds
• Visual requirements include close vision and the ability to adjust focus

Reasonable accommodations will be provided as needed.

Equal Employment Opportunity

Alignment Healthcare, LLC is proud to be an Equal Opportunity and Affirmative Action Employer.

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