Managed Care Contract Manager

The Christ Hospital Health Network; Cincinnati (OH); On-site; USD 90,000 - 130,000; Full time

Job summary

The Christ Hospital Health Network is seeking a Managed Care Contract Manager to lead payor contract lifecycle activities, support negotiations with data-driven insights, and optimize reimbursement while preserving revenue integrity. The role partners with Payor Relations and Revenue Cycle to align contracts with the organization’s managed care strategy.

Responsibilities include managing contract portfolios, specialty contracting for COE/bundled payments, CLM workflow modernization, and SCA

Qualifications

• Financial modeling and data analysis proficiency.
• Understanding of healthcare reimbursement models (MS/APR-DRGs, APCs, fee schedules, value-based care).
• Ability to translate complex financial data into actionable leadership insights.

Responsibilities

• Contract Management & Operations: Oversees a portfolio of payor contracts; updates language, amendments, and renewals aligned with pricing strategy.
• Specialty Contracting: Coordinates transplant contracting initiatives; oversight for COE and bundled payments.
• Optimization of Departmental Workflow: Modernizes contract documentation in CLM software; tracks key dates and contacts.
• Strategic Alignment: Ensures small payor agreements align with broader fiscal framework.
• Single Case Agreements (SCAs): Negotiates and executes out-of-network SCAs when standard contracts are absent.
• Financial Analysis & Strategic Support: Monitors post-implementation performance; identifies revenue leakage and deviations from terms.
• Price Transparency: Supports data requests to advance pricing strategy.
• Strategic Pre-Negotiation: Assists in building negotiation strategies with data-driven reports and yield analyses.
• Market Impact Modeling: Creates financial models to forecast bottom-line impact of rate restructures.

Job description

Job Description

The Managed Care Contract Manager manages payor contracts throughout their lifecycle, supporting contract negotiations, financial analysis, reimbursement optimization, and revenue integrity. As a member of the Payor Relations team and working closely with the Revenue Cyle team, this role uses data-driven insights to improve contract performance, support strategic negotiations, and maintain strong relationships with payor partners while ensuring alignment with the organization's managed care strategy.

Responsibilities

Contract Management & Operations

• Portfolio Management: Oversees, optimizes, and maintains a distinct portfolio of payor contracts with lesser total charge volume. Ensures all contract language updates, amendments, and timely renewals directly align with the organization's overarching managed care / pricing strategy.


• Specialty Contracting: Directs and coordinates specialized transplant contracting initiatives, alongside providing focused administrative oversight for Center of Excellence (COE) and bundled payment arrangements.


• Optimization of Departmental Workflow: Modernizes contract documentation into CLM software/virtual environment; noting important dates/major contract terms/contacts/etc.


• Strategic Alignment: Verifies that all specialized, single-case, and small payor agreements consistently protect and support the broader managed care fiscal framework.


• Single Case Agreements (SCAs): Efficiently negotiates, structures, and executes Single Case Agreements for out-of-network scenarios where standard active contracts are not currently established.

Financial Analysis & Strategic Support

• Performance Tracking: Regularly monitors, evaluates, and reports on the post-implementation financial performance of all assigned agreements relative to expected net reimbursement.


• Variance & Revenue Integrity: Identifies, tracks, and escalates instances of revenue leakage, systematic underpayments, or material deviations from negotiated contract terms.


• Price Transparency: Assists department with price transparency data requests, leveraging information to further TCH Managed Care contracting/pricing strategy.


• Strategic Pre-Negotiation: Actively assists the Director of Contract Management in building comprehensive negotiation strategies by engineering data-driven positioning reports, yield analyses, and historical performance reviews for major payors.


• Market Impact Modeling: Coordinates creating and orchestrating reports (i.e. robust financial models) with data analytics/decision support team(s) to simulate and forecast the true bottom-line impact of proposed rate restructures, alternative payment models (APMs), or contract updates during active negotiation cycles.

Qualifications

Education

• Master’s degree in Business or Healthcare Administration preferred. Bachelor’s degree in Healthcare Administration, Finance, Business Analytics, or a closely related professional discipline, or Associate’s degree and 5 or more years of equivalent verified experience in negotiation, contract management, or payor relations required.

Years of Experience

• 3-5 years of direct experience within a healthcare system, major provider group, or commercial payor environment and experience in negotiating reimbursement and other agreements between healthcare organizations required. Analytics within a healthcare payor and provider relationship setting preferred.

Required Skills and Knowledge

• Financial & Analytical Acumen: Proficiency in financial modeling, data analysis, and contract yield projections required. Advanced Excel capability is required, with experience digesting price transparency files among providers and payors – experience w/ JSON file format preferred.


• Reimbursement Methodologies: Solid, practical understanding of healthcare reimbursement models including MS/APR-DRGs, APCs, fee schedules, value-based care programs, and other payment models.


• Communication & Synergy: Demonstrated ability to translate highly technical or complex financial data into concise, actionable insights for leadership, while maintaining strong relationships with payor representatives.