Manager, Contract & Credentialing
The Contract and Credentialing Manager is responsible for supporting service area agreements with highly visible providers, including integrated delivery systems, hospitals, and physician groups. This role ensures contracts deliver high-quality, cost-effective, and marketable provider networks that meet organizational standards. The position also manages corporate and network contracts to support strategic goals and oversight of all delegated credentialing.
ESSENTIAL JOB RESPONSIBILITIES
- Manage high-priority physician group, facility, corporate, and network contracts in alignment with PADU (Preferred, Acceptable, Discouraged, Unacceptable) guidelines.
- Develop, negotiate, execute, and maintain provider contracts within contract management systems.
- Recruit and negotiate with providers to improve network access, reduce grievances, and support cost control strategies, including Medical Loss Ratio (MLR) optimization.
- Maintain effective relationships with key providers and advise Contract Coordinators and Specialists on provider and ancillary contract negotiations.
- Evaluate network performance and implement strategies to ensure compliance with network adequacy standards.
- Ensure contract language meets organizational and regulatory requirements in collaboration with legal counsel.
- Support development of fee schedules and reimbursement models in partnership with Corporate Network Management and legal.
- Educate internal stakeholders on provider contracting processes.
- Participate in strategic initiatives and organizational committees.
- Ensure timely submission of all required contracting related deliverables to the Oregon Health Authority.
- Collaborate with internal departments to gather data and documentation for OHA reporting.
- Oversee and coordinate Network Performance Subcommittee.
- Oversee delegated credentialing entities for compliance.
- Provide leadership and supervision to the Contracting and Network team.
- Perform other duties as assigned
Minimum Qualifications
- Bachelor’s degree in a healthcare-related field or equivalent combination of education and experience.
- 5–7 years of experience in Medicaid contracting and healthcare network management.
- Knowledge of Medicaid, Medicare and Commercial healthcare operations, compliance, and credentialing processes.
- Strong organizational, analytical, and problem-solving skills.
- Effective communication and interpersonal skills, with the ability to collaborate across teams.
- Ability to manage competing priorities and meet deadlines in a fast-paced environment.
- Accountability: Takes ownership of responsibilities and outcomes.
- Integrity: Maintains confidentiality and adheres to ethical standards.
- Innovation: Identifies opportunities for improvement and implementing solutions.
- Collaboration: Works effectively with diverse teams and stakeholders.
- Prolonged periods of sitting at a computer, with occasional standing and movement.
- Frequent use of hands and fingers for typing and standard computer tasks.
- Visual acuity required for extended screen use.
- Ability to communicate effectively via phone and virtual platforms.
- Must maintain a designated workspace with appropriate ergonomic setup.
- Requires a reliable internet connection and necessary technology.
- The work environment should support adequate lighting and minimal distractions.
- Regular, predictable attendance during Pacific Time Zone business hours is required.
UH is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. UH makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, read through our EEO Policy.
About Umpqua Health
At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Umpqua Health serves Douglas County, Oregon, where we prioritize personalized care and innovative solutions to meet the diverse needs of our members. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together. Join us in making a difference at Umpqua Health.
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.