Director of Managed Care Contracting and Analytics

Sturdy Memorial Hospital•Attleboro, MA

23h

About The Position

The Director of Managed Care Contracting is responsible for strategy, negotiation, and monitoring of third-party contracts across Sturdy Health. Working with Revenue Cycle and Population Health teams, the Director helps ensure the hospital and physician group are paid according to contract and succeed under value-based and risk arrangements. The Director serves as the primary liaison with third-party payers on contract terms and contributes to decisions about plan participation. The role leads contracting strategy and negotiations for hospitals, the physician group, and value-based arrangements; monitors payer performance, payments, utilization, and reimbursement; and supports compliance with applicable requirements. The Director also works with Population Health on the development and tracking of value-based programs, and with Budget and Decision Support on projections and analytics. Additional responsibilities include supporting monthly net revenue and accounts receivable valuation, preparing year-end revenue-related general ledger entries and audit work papers, and responding to audit questions. The position requires prolonged periods of sitting at a desk and working on a computer. The posted salary range is $139,296.01–$219,511.30. Actual compensation depends on factors such as work history, experience, skill set, and education. The posting states that the range is based on full-time employment and notes that the benefits package may include healthcare, dental, vision, and retirement benefits.

Requirements

Bachelor’s degree in Healthcare Administration, Finance, Business Administration, or a related field.
At least 5 years of managed care contracting and negotiation experience.
Strong negotiation, analytical, and relationship-management skills.
Extensive knowledge of hospital and physician provider payment arrangements and methods.
Deep knowledge of laws and regulations pertaining to the healthcare industry.
Effective written and oral communication skills with a wide variety of individuals and groups.
Ability to independently handle multiple unique, sensitive, and complex matters with minimal supervision and oversight.
Ability to relate to others in a way that gains support and promotes confidence.
Ability to maintain confidentiality and carry out assignments proficiently and professionally.
Commitment to the philosophy, mission, and values of Sturdy Health.
Ability to perform the essential functions, including required work hours, locations, and physical demands, with or without reasonable accommodation and without posing a direct threat to workplace health and safety.

Nice To Haves

Graduate degree.

Responsibilities

Oversee third-party contracting across the system, including hospitals, the physician group, and value-based arrangements.
Lead negotiations with third-party insurers to secure market-competitive rates for hospital and physician services.
Collaborate with executive leadership to align network contracting strategies with organizational goals and monitor market dynamics.
Develop and execute contracting strategies that anticipate market shifts, payer policy changes, and regulatory developments.
Build and maintain relationships with third-party insurers, promoting transparency, accountability, and alignment with organizational priorities; resolve issues and support effective negotiations.
Monitor and analyze third-party payments and payer performance, utilization trends, and reimbursement outcomes to identify improvement opportunities and mitigate risk.
Ensure accurate claim pricing through Strata contract configuration.
Ensure contracting activities comply with federal, state, and accreditation requirements.
Educate staff about contract parameters and changes, and communicate complex concepts to executives, physicians, and cross-functional partners.
Serve as the primary contact and resource for contract interpretation and managed care reimbursement issues.
Work with internal clients to resolve reimbursement issues, recommend process improvements, and recommend future contract changes to improve reimbursement and contract performance.
Partner with the Population Health Team to develop, value, and track shared savings, bundled payment, downside-risk, and capitation programs.
Monitor payer performance programs and risk arrangements to support strategic objectives and maximize financial performance.
Work with Budget and Decision Support to incorporate accurate projections and analytics into operational and strategic decisions.
Perform or review analyses related to payer policy changes, regulatory updates, reimbursement shifts, and negotiation strategy.
Assist with monthly net revenue and accounts receivable valuation.
Prepare year-end revenue-related general ledger entries and audit work papers, and respond to audit questions as appropriate.
Treat patients, colleagues, and visitors with dignity and respect, with sensitivity to differing needs and backgrounds.
Perform other duties as assigned; duties and responsibilities may change with or without notice.