Manager – Managed Care Contracts

Jobtailor; Morristown (NJ); On-site; USD 140,000 - 210,000; Full time

Job summary

Jobtailor in Morristown, NJ seeks an experienced Senior Managed Care Contracting professional to lead contracting across hospital and affiliated entities. You will evaluate, negotiate, and implement complex agreements, ensuring compliant terms and favorable reimbursement structures.

The role partners with Medical Economics and analytics to model financial impact, monitor payer performance, and drive value-based care initiatives.

Qualifications

• Bachelor's degree in healthcare administration or related field.
• 5–7 years of managed care contracting or revenue cycle experience in a complex healthcare environment.
• Experience negotiating hospital, ambulatory, and value-based reimbursement arrangements.
• Strong analytical, modeling, and negotiation skills.
• Experience with Epic systems preferred.

Responsibilities

• Manage all aspects of the contracting lifecycle across hospital, ancillary, physician, ambulatory, and affiliated entities.
• Evaluate, negotiate, and implement managed care agreements in compliance with policies and regulatory requirements.
• Ensure economically viable contract terms, reimbursement methodologies, and operational provisions.
• Assess the relationship between contract language, reimbursement methodologies, and revenue cycle performance.
• Develop and maintain strategic payer relationships.
• Collaborate with Medical Economics on contract analysis and financial modeling.

Skills

Managed Care Contracting

Reimbursement Methodologies

Financial Modeling

Value-Based Care Principles

Project Leadership

Cross-functional Collaboration

Negotiation

Education

Bachelor's degree in Healthcare Administration / related field

Tools

Epic Contract Management

Epic Resolute Hospital Billing

Epic Resolute Professional Billing

Microsoft Excel

Business Intelligence Tools

Job description

• Manage all aspects of the contracting lifecycle across hospital, ancillary, physician, ambulatory, and other affiliated healthcare entities
• Evaluate, negotiate, and implement managed care agreements in compliance with organizational policies, reimbursement standards, and regulatory requirements
• Ensure economically viable contract terms, reimbursement methodologies, and operational provisions
• Assess the relationship between contract language, reimbursement methodologies, operational workflows, and revenue cycle performance
• Develop and maintain strategic payer relationships
• Collaborate with Medical Economics on contract analysis, financial modeling, fee-for-service reimbursement strategies, and value-based initiatives
• Serve as the primary managed care advisor for revenue cycle, operational, and strategic initiatives
• Lead negotiations involving hospital, professional, ambulatory, ancillary, bundled payment, capitation, and risk-based arrangements
• Support development, negotiation, implementation, and performance management of value-based care arrangements
• Partner with analytical team on contract modeling, reimbursement analysis, and financial impact assessments
• Ensure accurate contract implementation and maintenance within Epic contract management and reimbursement systems
• Conduct market analyses and benchmarking using internal and external data sources
• Evaluate reimbursement yield, payment accuracy, underpayments, denials, and payer compliance
• Maintain updates related to governmental reimbursement methodologies, coding changes, regulatory requirements, and payer policy changes
• Support payer plan governance, including creation, maintenance, mapping, and deactivation
• Develop and maintain policies, procedures, standards, and controls for contract implementation and management
• Lead initiatives resolving contract-related operational issues affecting reimbursement, patient access, claims adjudication, and revenue integrity
• Represent managed care on organizational committees
• Monitor industry, payer, regulatory, and reimbursement trends and recommend strategic responses
• Present recommendations to senior leadership on payer strategy, reimbursement performance, contract opportunities, and emerging risks
• Supervise and guide team members responsible for contract implementation, modeling, analytics, and related managed care functions
• Escalate and manage risks, issues, and strategic decisions affecting managed care operations and financial performance

Requirements

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, Finance, Mathematics, Healthcare Informatics, or related field required
• Five to seven years of progressively responsible managed care contracting, healthcare finance, reimbursement, or revenue cycle experience in a complex healthcare environment
• Demonstrated experience negotiating and managing hospital, ancillary, physician, ambulatory, and value-based reimbursement arrangements
• Minimum three years of project leadership or management experience involving healthcare operations, finance, revenue cycle, information technology, or system implementations
• Experience leading cross-functional initiatives and influencing stakeholders across multiple business areas
• Extensive knowledge of managed care reimbursement methodologies, including fee-for-service, DRG, APC, per diem, case rates, CPT-based reimbursement, bundles, capitation, shared savings, shared risk, and pay-for-performance models
• Strong understanding of value-based care principles, population health management, quality measurement, and alternative payment models
• Advanced financial modeling, contract analysis, and reimbursement forecasting capabilities
• Knowledge of physician and hospital reimbursement methodologies, including DRGs, APCs, CPT coding, RVUs, and alternative payment structures
• Strong communication, negotiation, presentation, and relationship management skills
• Highly organized with strong analytical and problem-solving abilities
• Advanced proficiency in Microsoft Excel and business intelligence tools, including financial modeling, dashboards, complex formulas, and data analysis
• Preferred: EPIC Resolute Hospital Billing Expected Reimbursement
• Preferred: Epic Resolute Professional Billing Expected Reimbursement

Core Competencies

Demonstrates expertise in managed care contracting, reimbursement methodologies, and financial modeling within a complex healthcare environment. Proven ability to lead negotiations, develop strategic payer relationships, and implement value-based care arrangements.

Highest-signal resume keywords

• Managed Care Contracting
• Reimbursement Methodologies
• Financial Modeling
• Value-Based Care Principles
• Project Leadership

ATS Optimization Keywords

Hard Skills

• Contract Analysis
• Reimbursement Forecasting
• Negotiation
• Healthcare Finance
• Revenue Cycle Management
• Data Analysis
• CPT Coding
• DRG
• APC
• Capitation

Soft Skills

• Communication
• Presentation
• Relationship Management
• Analytical Abilities
• Problem-Solving

Industry Keywords

• Healthcare Administration
• Managed Care
• Value-Based Care
• Population Health Management
• Alternative Payment Models

Tools & Technologies

• Microsoft Excel
• Business Intelligence Tools
• Epic Contract Management
• Epic Resolute Hospital Billing
• Epic Resolute Professional Billing