Senior Value Based Care Contract Specialist

The Ohio State University

2d

About The Position

The Managed Care Department is responsible for developing and implementing the managed care strategies and objectives for the OSU Health System University Hospitals, The James, University Reference Labs and related entities (OSUHS). The department negotiates and manages agreements with managed care organizations and pursues initiatives related to improve OSUHSs ability to compete in a managed care environment. We are seeking an experienced Senior Managed Care Contracting Specialist with deep expertise in value‑based care (VBC) contracting and regulatory oversight across CMS and Ohio Medicaid programs. This role requires advanced analytical capability, strong payer‑provider contract interpretation skills, and hands‑on experience operationalizing VBC financial models. A special emphasis is placed on expertise with the Ohio Medicaid Comprehensive Integrated Care Incentive Program (CICIP), including regulatory requirements, methodology, reporting standards, and compliance obligations. The Senior Specialist will support contract development, negotiation, modeling, performance monitoring, and regulatory readiness for all value‑based payer agreements. This role partners closely with Managed Care, Population Health, Compliance, Finance, Legal, and Clinical Operations to ensure organizational success in current and emerging risk‑based payment structures. In the area of Value‑Based Contract Development and Negotiation, this role leads the strategy, development, and negotiation of complex VBC arrangements across Medicare Advantage, Medicaid Managed Care, and Commercial payers. The Senior Contract Specialist is responsible for shaping contract structures, aligning incentives, defining performance expectations, and ensuring financial and operational feasibility. While negotiation is the primary focus, the position also requires a strong understanding of analytical methodologies and financial modeling, enabling informed decision‑making and the ability to evaluate upside/downside risk, shared savings potential, quality incentive pathways, and performance‑based revenue opportunities. As the organization’s expert in managed care, CMS, and Ohio Medicaid regulatory requirements, the Senior Contract Specialist serves as the primary resource for value‑based payment structures, compliance expectations, and emerging payer strategies. The position interprets and operationalizes Ohio Medicaid managed care regulations, with specific expertise in the Comprehensive Integrated Care Incentive Program (CICIP). Responsibilities include leading organizational readiness, compliance alignment, and internal education on CICIP program design, performance metrics, incentive methodologies, data submission requirements, and provider performance expectations. In Financial and Performance Reporting, the position partners with analytic stakeholders to ensure contract terms are accurately modeled, tracked, and evaluated throughout the performance cycle. The specialist oversees the development of dashboards and reporting that quantify contract performance, incentive opportunities, and financial exposure. The role uses these insights to guide negotiation strategy, performance improvement recommendations, and long‑term value‑based care planning. Strong Cross‑Functional Collaboration is essential, as the Senior Contract Specialist works closely with clinical, operational, financial, and population health leaders to ensure value‑based arrangements are operationally feasible and strategically aligned with organizational capabilities. The role collaborates with legal teams to refine contract language, clarify regulatory obligations, and ensure compliant data‑sharing and reporting structures. In payer discussions, the specialist brings forward meaningful financial impact insights and performance forecasts to drive successful outcomes. Finally, within Compliance and Risk Management, the Senior Contract Specialist ensures all negotiated agreements adhere to managed care and regulatory standards, including documentation and audit readiness. The role ensures that contracts align with evolving regulatory expectations and that internal processes support accurate reporting, performance monitoring, and long‑term compliance. Through this work, the specialist ensures the organization is well‑positioned to succeed in current and future value‑based care arrangements.

Requirements

• Bachelor's Degree in Business Administration, Healthcare Admin, Finance, Public Health, Marketing ore related field.
• 4 years of relevant experience required.
• 3+ years of experience in managed care contracting, payer/provider analytics, or value‑based care program management
• Demonstrated experience with CMS VBC models and Ohio Medicaid managed care programs.
• In‑depth knowledge of Ohio Medicaid’s CICIP structure, metrics, financial methodologies, and reporting
• Excellent contract interpretation skills and the ability to translate technical terms into actionable insights
• Strong communication skills with the ability to influence stakeholders at all levels
• Ability to work under stress and deadlines, cope with frequent interruptions and prioritize
• Knowledge of healthcare terminology and reimbursement methods
• Familiarity with quality assurance and utilization review standards.
• Proficiency with MS Office suite.

Nice To Haves

• 4-8 years of relevant experience preferred.
• Master's preferred.

Responsibilities

• Lead the strategy, development, and negotiation of complex VBC arrangements across Medicare Advantage, Medicaid Managed Care, and Commercial payers.
• Shape contract structures, aligning incentives, defining performance expectations, and ensuring financial and operational feasibility.
• Serve as the primary resource for value‑based payment structures, compliance expectations, and emerging payer strategies.
• Interpret and operationalize Ohio Medicaid managed care regulations, with specific expertise in the Comprehensive Integrated Care Incentive Program (CICIP).
• Lead organizational readiness, compliance alignment, and internal education on CICIP program design, performance metrics, incentive methodologies, data submission requirements, and provider performance expectations.
• Partner with analytic stakeholders to ensure contract terms are accurately modeled, tracked, and evaluated throughout the performance cycle.
• Oversee the development of dashboards and reporting that quantify contract performance, incentive opportunities, and financial exposure.
• Work closely with clinical, operational, financial, and population health leaders to ensure value-based arrangements are operationally feasible and strategically aligned with organizational capabilities.
• Collaborate with legal teams to refine contract language, clarify regulatory obligations, and ensure compliant data‑sharing and reporting structures.
• Ensure all negotiated agreements adhere to managed care and regulatory standards, including documentation and audit readiness.

Benefits

• An array of retirement plan options, each with a generous employer contribution.
• Affordable health insurance options, including dental, vision and prescription coverage that begin on day one.
• Paid vacation and sick leave, including short and long-term disability and paid parental leave.
• Get the most out of the Public Service Loan Forgiveness program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level