Managed Care Contract Manager

As a member of the Payor Relations team and working closely with the Revenue Cyle team, this role uses data-driven insights to improve contract performance, support strategic negotiations, and maintain strong relationships with payor partners while ensuring alignment with the organization's managed care strategy. Market Impact Modeling: Coordinates creating and orchestrating reports (i.e. robust financial models) with data analytics/decision support team(s) to simulate and forecast the true bottom-line impact of proposed rate restructures, alternative payment models (APMs), or contract updates during active negotiation cycles.

Job Description

The Managed Care Contract Manager manages payor contracts throughout their lifecycle, supporting contract negotiations, financial analysis, reimbursement optimization, and revenue integrity. As a member of the Payor Relations team and working closely with the Revenue Cyle team, this role uses data-driven insights to improve contract performance, support strategic negotiations, and maintain strong relationships with payor partners while ensuring alignment with the organization's managed care strategy.

Responsibilities

Contract Management & Operations

• Portfolio Management: Oversees, optimizes, and maintains a distinct portfolio of payor contracts with lesser total charge volume. Ensures all contract language updates, amendments, and timely renewals directly align with the organization's overarching managed care / pricing strategy.
• Specialty Contracting: Directs and coordinates specialized transplant contracting initiatives, alongside providing focused administrative oversight for Center of Excellence (COE) and bundled payment arrangements.
• Optimization of Departmental Workflow: Modernizes contract documentation into CLM software/virtual environment; noting important dates/major contract terms/contacts/etc.
• Strategic Alignment: Verifies that all specialized, single-case, and small payor agreements consistently protect and support the broader managed care fiscal framework.
• Single Case Agreements (SCAs): Efficiently negotiates, structures, and executes Single Case Agreements for out-of-network scenarios where standard active contracts are not currently established.

Financial Analysis & Strategic Support

• Performance Tracking: Regularly monitors, evaluates, and reports on the post-implementation financial performance of all assigned agreements relative to expected net reimbursement.
• Variance & Revenue Integrity: Identifies, tracks, and escalates instances of revenue leakage, systematic underpayments, or material deviations from negotiated contract terms.
• Price Transparency: Assists department with price transparency data requests, leveraging information to further TCH Managed Care contracting/pricing strategy.
• Strategic Pre-Negotiation: Actively assists the Director of Contract Management in building comprehensive negotiation strategies by engineering data-driven positioning reports, yield analyses, and historical performance reviews for major payors.
• Market Impact Modeling: Coordinates creating and orchestrating reports (i.e. robust financial models) with data analytics/decision support team(s) to simulate and forecast the true bottom-line impact of proposed rate restructures, alternative payment models (APMs), or contract updates during active negotiation cycles.

Qualifications

EDUCATION:

• Master's degree in Business or Healthcare Administration preferred. Bachelor's degree in Healthcare Administration, Finance, Business Analytics, or a closely related professional discipline, or Associate's degree and 5 or more years of equivalent verified experience in negotiation, contract management, or payor relations required.

YEARS OF EXPERIENCE:

• 3-5 years of direct experience within a healthcare system, major provider group, or commercial payor environment and experience in negotiating reimbursement and other agreements between healthcare organizations required. Analytics within a healthcare payor and provider relationship setting preferred.

REQUIRED SKILLS AND KNOWLEDGE:

• Financial & Analytical Acumen: Proficiency in financial modeling, data analysis, and contract yield projections required. Advanced Excel capability is required, with experience digesting price transparency files among providers and payors - experience w/ JSON file format preferred.
• Reimbursement Methodologies: Solid, practical understanding of healthcare reimbursement models including MS/APR-DRGs, APCs, fee schedules, value-based care programs, and other payment models.
• Communication & Synergy: Demonstrated ability to translate highly technical or complex financial data into concise, actionable insights for leadership, while maintaining strong relationships with payor representatives.