About The Role

Manager, Managed Care Contracting

Overview

The Manager, Managed Care Contracting reports to the Director of Managed Care and is responsible for the end-to-end contracting lifecycle across hospital, ancillary, physician, ambulatory, and value-based care arrangements. This individual leads the assessment, development, implementation, and ongoing management of complex contractual relationships in support of organizational strategic, financial, operational, and population health objectives. The Manager serves as a key managed care leader, collaborating across Revenue Cycle, Medical Economics, Population Health, Finance, Clinical Operations, Information Technology, and Executive Leadership to optimize reimbursement, evaluate contract performance, and drive payer strategy. Through partnership with data, analytics, and operational stakeholders, this role identifies opportunities to strengthen contract structure, improve financial outcomes, and support both fee-for-service and value-based reimbursement models. This position oversees enterprise managed care contracting activities, ensuring contracts are strategically aligned, operationally executable, and financially sustainable while supporting organizational growth, revenue integrity, and evolving value-based care initiatives.

Responsibilities

Managed Care Contracting

Manage all aspects of the contracting lifecycle across hospital, ancillary, physician, ambulatory, and other affiliated healthcare entities.
Evaluate, negotiate, and implement managed care agreements in compliance with organizational policies, reimbursement standards, and regulatory requirements.
Ensure economically viable contract terms, reimbursement methodologies, and operational provisions.
Assess and understand the relationship between contract language, reimbursement methodologies, operational workflows, and revenue cycle performance.
Develop and maintain strategic payer relationships to advance organizational growth, market positioning, and reimbursement objectives.
Collaborate with Medical Economics to support contract analysis, financial modeling, fee-for-service reimbursement strategies, and value-based initiatives.
Serve as the primary managed care advisor for revenue cycle, operational, and strategic initiatives across the enterprise.
Lead negotiations involving complex reimbursement methodologies, including hospital, professional, ambulatory, ancillary, bundled payment, capitation, and risk-based arrangements.

Value-Based Contracting & Population Health

Support in the development, negotiation, implementation, and ongoing performance management of value-based care arrangements.
Support organizational strategy related to risk-based reimbursement and value transformation initiatives.

Contract Modeling, Analytics & Revenue Integrity

Partner with analytical team to lead contract modeling, reimbursement analysis, and financial impact assessments for all managed care negotiations.
Ensure accurate contract implementation and maintenance within Epic contract management and reimbursement systems.
Conduct market analyses and benchmarking using internal and external data sources.
Evaluate reimbursement yield, payment accuracy, underpayments, denials, and payer compliance with contractual obligations.
Ensure timely updates related to governmental reimbursement methodologies, coding changes, regulatory requirements, and payer policy changes.

Epic & Operational Governance

Oversee the accurate implementation and maintenance of payer contracts and reimbursement methodologies within Epic.
Support payer plan governance processes to ensure accurate creation, maintenance, mapping, and deactivation of payer plans.
Develop and maintain policies, procedures, standards, and controls related to contract implementation and management.
Lead initiatives to resolve contract-related operational issues impacting reimbursement, patient access, claims adjudication, and revenue integrity.

Strategic Leadership

Serve as the managed care representative on organizational committees focused on reimbursement, operational efficiency, technology assessment, population health, and strategic growth initiatives.
Monitor industry, payer, regulatory, and reimbursement trends and recommend strategic responses.
Assess payer policies and reimbursement changes to identify financial and operational impacts.
Lead efforts to address significant payer issues including denials, underpayments, policy changes, and contract compliance concerns.
Provide presentations and recommendations to senior leadership regarding payer strategy, reimbursement performance, contract opportunities, and emerging risks.
Supervise and provide guidance to team members responsible for contract implementation, modeling, analytics, and related managed care functions.
Proactively escalate and manage risks, issues, and strategic decisions impacting managed care operations and financial performance.

Qualifications

Education

Bachelor's degree in Healthcare Administration, Business Administration, Public Health, Finance, Mathematics, Healthcare Informatics, or related field required.
Master's degree in Business Administration, Health Administration, Public Health, Finance, or related discipline strongly preferred.

Experience

Five to seven years of progressively responsible managed care contracting, healthcare finance, reimbursement, or revenue cycle experience in a complex healthcare environment.
Demonstrated experience negotiating and managing hospital, ancillary, physician, ambulatory, and value-based reimbursement arrangements.
Minimum three years of project leadership or management experience involving healthcare operations, finance, revenue cycle, information technology, or system implementations.
Experience leading cross-functional initiatives and influencing stakeholders across multiple business areas.

Knowledge & Skills

Extensive knowledge of managed care reimbursement methodologies, including fee-for-service, DRG, APC, per diem, case rates, CPT-based reimbursement, bundles, capitation, shared savings, shared risk, and pay-for-performance models.
Strong understanding of value-based care principles, population health management, quality measurement, and alternative payment models.
Advanced financial modeling, contract analysis, and reimbursement forecasting capabilities.
Knowledge of physician and hospital reimbursement methodologies, including DRGs, APCs, CPT coding, RVUs, and alternative payment structures.
Strong communication, negotiation, presentation, and relationship management skills.
Highly organized with strong analytical and problem-solving abilities.
Advanced proficiency in Microsoft Excel and business intelligence tools, including financial modeling, dashboards, complex formulas, and data analysis.