About Gold Kidney Health Plan

Gold Kidney Health Plan is a newly founded Medicare Advantage health plan that launched in Arizona in 2023 plans to enter Florida for 2024. We will serve Medicare beneficiaries in Broward, Clay, Duval, Hernando, Manatee, Pasco, Pinellas, Sarasota, and Palm Beach counties in Florida. Our employees are passionate about providing the best services to our members and healthcare providers. Our corporate office is located in Scottsdale, Arizona and our Florida office is located in Tampa. To learn more please visit https://app-gkwpwebsite-prod.azurewebsites.net

Job Summary

Develops the Florida Medicare provider network through contract negotiations, relationship development, and servicing for large health systems and affiliated physician groups including employed and hospital based, and hospital owned ancillary providers. The primary focus of this role is contracting and negotiating contract terms. Deals with complex health systems, affiliated providers and drives and support value base initiatives. Individual contributor role, not a people manager.

Functions & Responsibilities:

• Serve in a leadership capacity, leading associate resources, special projects / initiatives, or network planning.
• Serve as a subject matter expert for local contracting efforts or in highly specialized components of the contracting process and serves as subject matter expert for that area for a business unit.
• Typically serve as lead contractor for large scale, multi-faceted negotiations.
• Serve as business unit representative on enterprise initiatives around network management and leads projects with significant impact.
• Assist management in network development planning.
• Provide work direction and establish priorities for field staff and may be involved in team associate development and mentoring.
• Involve non-standard arrangements that require a high level of negotiation skills, Understanding of customized fee schedules and compensation arrangements.
• Works independently with high level of judgment and discretion.
• May work on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management.
• May collaborate with sales team in making presentations to employer groups.
• Serve as a communication link between providers and the company.
• Conduct the most complex negotiations.
• Prepare financial projections and conduct analysis.
• Performs other duties as assigned.

May require travel up to 30%.

Education & Experience::

Requires a BA / BS degree and a minimum of 8 years’ experience in managed contracting (value based, shared savings and ACO development), provider relations, provider servicing.

Experience must include prior Medicare contracting experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Experience using financial models and analysis to negotiate rates with providers strongly preferred.

• Master’s Degree preferred. + Previous experience with transplant contracting and execution of Global Value Based Payment Models preferred.

• Strong negotiation skills, critical thinking, analytical skills, and knowledge of contract language.

Physical Demands and Working Conditions:

Combination of Office and Field work with travel to establish relationships and discuss contract opportunities with providers.