Contract Manager – Managed Care

This is a fully remote position, open to applicants in Florida, +2 more states.

📋 Description

• Negotiate and renegotiate managed care contracts.

• Oversee and coordinate administrative, legal, operational, and financial aspects related to contract negotiations.

• Maintain a comprehensive database of payer and managed care intelligence.

• Develop responses to requests for proposals from managed care organizations.

• Facilitate educational and training materials for managed care, aimed at payer contract services, physicians, office managers, and participating provider staff.

• Manage a defined array of payer agreements, including PPO, ancillary, physician, and other managed care contracts.

• Update rates and contract terms as necessary.

• Assemble and coordinate negotiation teams involving legal, finance, payer contract services, and operations.

• Evaluate new payer relationships in accordance with standard CCHS terms and contract objectives.

• Recommend updates to standard CCHS contracts and business terms.

• Suggest alternative legal language as appropriate.

• Coordinate contract modifications proposed by CPP, hospitals, legal, risk management, and UM/QA.

• Assess opportunities and financial terms related to hospital and physician contracts.

• Maintain a chronological record of managed care proposals and counterproposals.

• Evaluate legal risks associated with contract provisions.

• Draft responses and fulfill additional information requests from managed care plan representatives.

• Develop proposals in response to requests for proposals from managed care plans.

• Provide strategic and financial insights to foster profitable payer growth.

• Review quantitative models to assess the impact of proposals on hospital and physician practice managers.

• Support ongoing assessment and enhancement of care and service quality.

• Participate in annual budget planning and establish contracting goals, strategies, activity plans, and projections.

• Collaborate with marketing to create and promote new products while enhancing revenue from existing offerings.

• Perform additional duties as assigned.

⛳️ Requirements

• Must reside in Ohio, Florida, or Nevada.

• Bachelor's Degree is required.

• A minimum of three years of contracting experience in a payor, provider, or other relevant contract environments, including negotiation of financial/contract terms and development of contract language.

• Proficient understanding of advanced managed care methodologies and practices.

• Familiarity with managed care operations, physician office practices, hospital admissions, billing, and utilization review operations.

• Strong negotiation skills along with exceptional analytical and financial capabilities.

• Proficient in PC skills and experienced with Microsoft Office applications.

• Experience in managed care settings.

• Background across multiple service lines, such as heart and vascular, transplant, and women’s health.

• Experience in health system-based managed care contracting.

• Practical experience in negotiating and managing health insurance contracts.

• Ability to communicate effectively and exchange accurate information.

• Capability to perform work in a stationary position for extended durations.

• Competence in handling physical records or operating a computer and other office equipment.

• Must adhere to standard precautions and use personal protective equipment as needed.

• Compliance with the influenza prevention program is required, including annual vaccination or an approved exemption.

🏝️ Benefits

• Full-time employment.

• Remote work opportunity from 8:00 a.m. to 5:00 p.m.

• Annual half-day, on-site team meeting in Cleveland.

• Annual influenza vaccination program or approved exemption.

• Drug-free workplace with controlled-substance testing post-offer.

• Equal employment opportunity workplace.