Director, Managed Care Contracting (CCRM)

Unified Women's Healthcare • UNAVAILABLE, Florida

20h

About The Position

The Director, Managed Care Contracting is a leadership role on CCRM Fertility’s Payor Relations team, responsible for contracting strategy, execution, and team oversight. The role manages contracting professionals and oversees a portfolio of high-value managed care agreements across assigned territories or nationally. It combines negotiation, financial analysis, team leadership, and contract lifecycle management to optimize reimbursement, mitigate risks, and support operational efficiency and organizational growth.

The Director manages contract analysis, rate and language negotiations, implementation, and post-signature execution; works with Payor Strategy and Payor Relations & RCM leadership on payor fee schedules and contract terms; and evaluates network adequacy and market expansion opportunities. The role coordinates approval processes with legal, executives, and internal stakeholders, and partners with RCM, Credentialing, and Operations to communicate contractual changes and resolve operational issues tied to payor terms.

The position serves as a subject matter expert on managed care contract language, fee schedules, and administrative terms. It oversees the ContractWorks repository and related data integrity, tracking protocols, and milestone alerts; conducts payer landscape research and gap analyses; represents CCRM in relationships with payors and other external partners; and prepares leadership reports on contract pipelines, payer yield, renegotiation timelines, risks, and opportunities. The Director directly supervises and develops Contract Managers and Contract Administrators, establishes standard operating procedures, and manages team capacity and task delegation.

Requirements

• 5–10 years of direct managed care contracting experience within a physician group, clinic network, or payor organization.
• Proven track record managing and negotiating complex physician group and ancillary provider contracts.
• Experience in people management, including directing, coaching, and developing direct reports.

Nice To Haves

• Fertility experience.
• Experience with a Fertility Benefit Manager or Fertility Provider Network.

Responsibilities

• Manage a portfolio of complex, high-value managed care agreements, including contract analysis, rate negotiation, contract language interpretation and negotiation, implementation, and post-signature execution.
• Review payor fee schedule terms and structures and negotiate agreement terms, pricing structures, and fee schedules in alignment with financial parameters and strategic goals.
• Evaluate network adequacy, research new territories, conduct gap analyses, and recommend payer participation or non-participation.
• Facilitate pre-contract and post-signature approvals with legal, executive leadership, and internal stakeholders.
• Coordinate with RCM, Credentialing, and Operations to communicate contractual updates, fee schedule changes, and payor policy adjustments.
• Serve as the subject matter expert on managed care contract language, fee schedules, and administrative terms, translating clauses into operational guidelines.
• Oversee the ContractWorks contract repository, including data integrity, standardized tracking, and automated alerts for rate adjustments, renewals, and termination notice windows.
• Help resolve systemic operational issues related to billing, claims payment, scheduling, registration, and credentialing that are tied to payor contract terms.
• Lead payer landscape research and gap analyses for new practice integrations and market expansions, providing data-driven recommendations on payer participation and contract alignment.
• Cultivate and maintain relationships with health plans, third-party payors, employers, and external partners.
• Conduct regular outreach and meetings with payor representatives to resolve escalated administrative issues, negotiate terms, and align on shared objectives.
• Prepare and present periodic status reports and operational analyses covering contract pipeline progress, payer yield, renegotiation timelines, risks, and opportunities.
• Supervise, mentor, and develop Contract Managers and Contract Administrators; set performance expectations, accountability, and daily workflows.
• Establish standard operating procedures for contract intake, data entry, tracking, and execution workflows.
• Assess team bandwidth, optimize task delegation, and support ongoing skill development.

Benefits

• Medical, dental, and vision plans; fertility benefits; supplemental insurance options.
• Vacation, personal days, and paid holidays.
• 401(k) with employer contribution.
• Flexible Spending Accounts and Health Savings Accounts.
• Short- and long-term disability.
• Paid parental leave.
• Basic life insurance and optional additional coverage.
• Employee Assistance Program.
• Commuter benefits.
• Pet insurance.
• Identity theft protection.
• Professional development opportunities and resources.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: No Education Listed