Manager, Contract Management and Execution

L.A. Care Health Plan•Los Angeles, CA

3d•$102,183 - $163,492

About The Position

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. The Manager of Contract Management and Execution manages the full lifecycle of non-contracted provider agreements, responsibilities include negotiating business terms with providers, ensuring agreements clearly define services, rates, and operational requirements for accurate authorization and payment. The Manager evaluates reimbursement proposals, escalates exceptions, and provides leadership with clear recommendations. It maintains robust documentation and controls agreement retrieval and compliance. Collaborations with key stakeholders. Ensures timely provider arrangements and continuity of care. The role addresses network adequacy and access gaps, prioritizes urgent requests, and recommends sustainable solutions for recurring non-contracted provider use. Leading negotiations, the Manager applies organizational guidelines and analyzes utilization, payment history, and market conditions. Coordination with cross-functional teams operationalizes terms and resolves claims issues, while partnership with Legal and Compliance ensures regulatory alignment. The manager establishes standardized processes, develops performance metrics, drives continuous improvement, and coaches staff to foster accountability and member-centered decision-making. The Manager manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. Participates and makes recommendations on the department's strategic planning and/or long-term decision-making.

Requirements

At least 5 years of experience in managed care, provider contracting, network management, provider relations, reimbursement, and network operations.
At least 3 years of experience leading staff, supervising staff or people management.
Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.
Experience negotiating and administering provider agreements, LOAs, single-case agreements, MOUs, and other health care contractual arrangements.
Working knowledge spans managed care reimbursement methodologies, provider contracting principles, claims administration, authorization processes, and network operations.
Prior experience leading projects, workstreams, or staff within complex, matrixed health care environments.
Adept at coordinating complex issues across multiple operational functions and managing time-sensitive provider or member access matters.
Demonstrated ability to analyze financial and operational information enables them to translate findings into actionable negotiation or business decisions.
Demonstrates expertise in negotiating reimbursement and business terms, skillfully balancing member access, provider considerations, financial stewardship, and organizational objectives.
Strong knowledge and understanding of provider networks, reimbursement methodologies, authorization, claims adjudication, provider configuration, and health plan operations.
Adept at assessing provider availability and access needs, distinguishing between immediate member-specific solutions and broader network deficiencies that require strategic intervention with the abilities that include evaluating reimbursement proposals, utilization patterns, financial exposure, and alternative contracting approaches.
Advance detail skills, they interpret and operationalize agreement language, identifying terms that may create downstream claims, configuration, financial, or compliance risks.
Analytical skills that enable them to assess complex provider and member access issues, identify root causes, develop alternatives, and recommend practical solutions.
Strong written, verbal communication, presentation, and interpersonal skills allow them to communicate effectively with providers, operational leaders, clinicians, attorneys, finance professionals, and senior leadership.
Strong interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment. Ability to guide and support team members.
Excellent ability to set clear goals, develop strategic plans to achieve those goals, and inspire others to work towards a shared vision.
Skilled in mediating disputes and resolving conflicts in a fair and constructive manner.
Must have a deep understanding of financial principles.
Ability and excellent knowledge in developing and managing budgets, forecasting future financial outcomes, and making informed decisions about resource allocation.
Demonstrated ability to make informed decisions.
Deep understanding of the industry, market dynamics, and organizational operations to identify opportunities and navigate challenges.
Strong ability and knowledge to analyze market trends, anticipate future changes, and develop long-term strategies that align with the company's goals.

Nice To Haves

Experience using contract lifecycle management, provider data management, claims, workflow, or network management platforms.
Advanced knowledge of provider reimbursement methodologies, including fee-for-service, percentage-of-Medicare, case rates, per diem arrangements, bundled reimbursement, and other negotiated payment structures.
Knowledge of federal and state requirements affecting continuity of care, network adequacy, timely access, out-of-network services, and provider reimbursement.
Advanced proficiency with reporting and analytical tools used to evaluate agreement volume, reimbursement trends, turnaround times, and financial impact.
Demonstrated ability to convert recurring transactional activity into actionable network development and contracting strategy.

Responsibilities

Manages the full lifecycle of non-contracted provider agreements including Letters of Authorization (LOAs), Memorandum of understanding (MOUs,) and single-case arrangements by overseeing intake, negotiation, execution, implementation, renewal, and termination.
Negotiates business terms with hospitals, physicians, and other providers, ensuring agreements clearly define services, rates, and operational requirements to support accurate authorization and payment.
Translates negotiated terms into clear operational requirements and coordinate successful implementation across multiple departments.
Management of a high-volume portfolio of concurrent and time-sensitive agreements, maintaining appropriate documentation, controls, and follow-through.
Establishes expectations, influences cross-functional stakeholders, manages escalations, and develops staff within a matrixed organization.
Evaluates proposed reimbursement arrangements against established parameters, escalating agreements requiring exceptions, and providing leadership with clear recommendations.
Maintains robust documentation and controls to ensure agreements are retrievable, accurately implemented, and appropriately approved.
Collaborates and works with cross functional teams to facilitate timely provider arrangements that preserve member access and continuity of care.
Supports resolution of network adequacy and access gaps, prioritizing urgent and clinically significant requests while balancing organizational financial stewardship.
Identifies recurring use of non-contracted providers and recommends sustainable network solutions when needed.
Leads negotiations to establish reasonable reimbursement arrangements, applying organizational guidelines and analyzing utilization, payment history, and market conditions.
Coordinates with cross-functional teams ensure negotiated terms are operationalized and facilitates resolution of claims or payment issues.
Partners with Legal and Compliance ensures agreement templates and practices align with regulatory requirements.
Establishes standardized processes for agreement management, develops performance metrics and reporting, and drives continuous improvement initiatives.
Manage staff, including, but not limited to: monitoring of day-to-day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.
Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.
Responsible for reporting, budgeting, and policy implementation.
Performs other duties as assigned.