Sr Contract Manager, Managed Care Contracting

UMass Memorial Health•Worcester, MA

1d•Onsite

About The Position

This position provides strategic leadership for enterprise-level managed care contracting. The role involves the development, negotiation, and execution of complex, high-risk payer agreements that significantly impact organizational revenue, value-based performance, and long-term payer strategy. At UMass Memorial Health, everyone is considered a caregiver, playing an important role in the pursuit of healing for patients, the community, and each other. The health system comprises over 20,000 employees working together.

Requirements

BS degree or equivalent in Business, Health Care Administration, or Managed Care Administration.
7 years’ experience in hospital, physician office, clinical or managed care setting.
Thorough understanding of clinical operations, health care terminology, and current market conditions.
5 years’ direct managed care-contracting experience.
Direct experience analyzing and negotiating complex contracts.
Thorough understanding of intricate managed care financial arrangements and boilerplate negotiations.
Advanced expertise with value-based contracting required.
Proficiency with Microsoft Office applications.
Solid negotiation skills necessary for contract negotiations.
Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Nice To Haves

Master’s (MBA, MHA, MPH or JD strongly preferred)
Strong knowledge of commercial Medicare Advantage and Managed Medicaid markets preferred.
Excellent verbal and written communication skills.

Responsibilities

Leads enterprise-wide, high-dollar payer negotiations with limited executive oversight.
Serves as final preparer and internal presenter of negotiation strategy and recommendations to leadership.
Directs advanced financial modeling and scenario analysis.
Assesses and advises leadership on long-term financial, operational, and regulatory risk.
Authorized to negotiate and recommend contract terms within defined financial thresholds.
Exercises independent judgment in resolving complex payer disputes with material financial impact.
Responds to all inquiries relating to high volume managed care contracts from medical center personnel, physicians and/or physicians office staff.
Interprets contract language and ensures that the terms of contracts are communicated and implemented accurately within the system.
Resolves issues relating to health plan credentialing, claims payment, referral management, and various administrative issues.
Develops and standardizes contracting templates, negotiation guidelines, and best practices.
Plays a lead role in shaping payer strategy, contracting policy, and market positioning.
Coordinates site visits required for credentialing for new and existing programs.
Acts as primary liaison with high volume managed care plans in addressing operational issues arising under the managed care contracts.
Meets regularly with representatives from the high-volume managed care plans to ensure contractual obligations are met and to resolve issues raised by UMass Memorial Medical Center and UMass Memorial Medical Group personnel.
Manages high volume contracts to ensure compliance and, collaborates with the Director, Legal, Finance, and other departments as appropriate, is responsible for renewing and renegotiating contract terms.
Drives financial analysis and negotiation of value-based contracts.
Collaborates on contracting for ancillary services, including home health & hospice and MRI services, and affiliate hospital risk contracts.
Drives resolution of technical and operational problems.
Evaluates the impact of solutions to ensure goals are achieved.
Serves as a technical subject-matter expert and mentor for Contract Managers.
May act in a lead role on cross-functional initiatives involving Legal, Finance, Compliance, and Operations.
Primary liaison for internal departments and member hospital staff requiring out of network single case agreement negotiations.
Responsible for negotiating applicable single-case agreements.
Collaborates with leadership on departmental priorities and goals in relation to contract renewal.