Managed Care Contracting and Performance Advisor

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Managed Care Contracting and Performance Advisor based in the United States.

In this role, you will drive managed care contracting strategies that strengthen financial performance, optimize reimbursement, and improve relationships with healthcare payers. You will evaluate existing agreements, analyze reimbursement structures, and support complex negotiations with commercial and government-sponsored health plans. Working closely with Finance, Revenue Cycle, Operations, Physician Services, and payer partners, you will help translate contractual terms into actionable operational improvements. Through financial modeling, performance monitoring, and data-driven recommendations, you will identify revenue opportunities, reduce payment discrepancies, and mitigate contractual risks. You will also contribute to strategic initiatives involving physician networks, value-based care, and alternative payment models. This opportunity combines strategic advisory work with hands-on contract analysis in a collaborative, results-oriented healthcare environment.

• Evaluate managed care contracts: Review and audit existing agreements to identify opportunities for improved reimbursement, optimized contract terms, stronger compliance, and successful renegotiation.
• Conduct financial and reimbursement analysis: Build financial models and assess the impact of proposed rate changes, contract amendments, new payer arrangements, and alternative reimbursement structures.
• Assess contractual risks: Interpret complex contract language, reimbursement methodologies, payment policies, authorization requirements, carve-outs, and contractual obligations to identify financial, operational, and compliance risks.
• Develop contracting strategies: Prepare business cases, financial assessments, and executive-level recommendations to support contract decisions and align payer agreements with organizational objectives.
• Support payer negotiations: Develop and execute negotiation strategies involving commercial insurance plans, Medicare Advantage, Managed Medicaid, and other managed care organizations.
• Prepare negotiation proposals: Analyze payer offers, develop data-supported counterproposals, and recommend improvements to reimbursement rates, payment methodologies, revenue protection provisions, and operational requirements.
• Manage payer relationships: Maintain productive relationships with payer representatives, resolve negotiation challenges, and facilitate the timely execution of agreements.
• Coordinate contract implementation: Partner with Finance, Revenue Cycle, Patient Access, Case Management, Physician Services, and other stakeholders to implement new and amended agreements effectively.
• Translate contract terms into operational guidance: Develop and maintain contract summaries, reimbursement guides, reference materials, and educational resources that clarify contractual requirements for operational teams.
• Support billing and reimbursement configuration: Assist with payer configuration, billing implementation, reimbursement validation, and operational training to ensure accurate execution of negotiated agreements.
• Monitor contract performance: Establish and track key performance indicators related to reimbursement accuracy, payment timeliness, denial trends, underpayments, payment variances, and revenue yield.
• Resolve reimbursement issues: Investigate and escalate complex underpayments, denials, payment discrepancies, and contractual disputes in collaboration with Revenue Cycle leadership and relevant stakeholders.
• Identify revenue improvement opportunities: Analyze payer performance and reimbursement trends to uncover revenue recovery opportunities, improve contract compliance, and reduce financial leakage.
• Report performance and financial impact: Prepare executive-level reports and presentations covering contract performance, negotiation progress, financial outcomes, and strategic recommendations.
• Support strategic growth initiatives: Evaluate opportunities involving new payers, independent physician associations (IPAs), medical groups, and physician networks to expand patient access and referral opportunities.
• Contribute to alternative payment models: Support value-based care, risk-based contracting, and other innovative reimbursement arrangements where appropriate.
• Drive measurable results: Help improve negotiated reimbursement rates, contract implementation, payment accuracy, dispute resolution, operational effectiveness, and overall financial performance.

Requirements

• Education and experience: Bachelor's degree with at least 6–8 years of relevant professional experience, or an associate degree with at least 8–10 years of relevant experience. Equivalent relevant experience may be considered in place of formal education.
• Relevant industry background: Experience in healthcare provider organizations, central business offices, managed care, contracting, healthcare finance, payer relations, healthcare administration, or revenue cycle outsourcing.
• Managed care contracting: Demonstrated experience reviewing, evaluating, or negotiating healthcare agreements, preferably with commercial insurers and government-sponsored health plans.
• Reimbursement analysis: Experience conducting financial analyses, reimbursement evaluations, contract assessments, and financial modeling to support contracting and business decisions.
• Healthcare reimbursement knowledge: Understanding of hospital and physician reimbursement methodologies, including Medicare, Medicaid/Medi-Cal, diagnosis-related groups (DRGs), ambulatory payment classifications (APCs), fee schedules, capitation, and value-based payment models.
• Contract interpretation: Ability to interpret complex contractual provisions, identify financial and operational implications, and translate contract language into practical implementation requirements.
• Analytical and financial modeling skills: Strong quantitative and problem-solving abilities, with the capacity to evaluate payer proposals, assess reimbursement trends, forecast financial impact, and identify opportunities for revenue improvement.
• Negotiation and relationship management: Strong negotiation, communication, and interpersonal skills, with the ability to build productive relationships with payer representatives and internal stakeholders.
• Cross-functional collaboration: Ability to work effectively with Finance, Revenue Cycle, Operations, Physician Services, and other departments across different organizational levels.
• Project management: Strong organizational skills and the ability to coordinate contract implementation, manage competing priorities, meet deadlines, and drive initiatives from analysis through execution.
• Reporting and presentation: Ability to communicate complex financial and contractual information clearly through written reports, presentations, and executive-level recommendations.
• Technical proficiency: Proficiency in Microsoft Excel and PowerPoint, with experience using healthcare financial analytics and reporting tools.
• Strategic thinking: Ability to connect contracting decisions with broader financial objectives, operational performance, patient access, and organizational growth.
• Adaptability and initiative: A proactive, detail-oriented approach to identifying risks, resolving complex issues, and implementing sustainable improvements.

Benefits

• Competitive compensation: Annual salary range of $113,000–$188,000, depending on experience, qualifications, skills, training, and organizational considerations.
• Performance incentives: Potential eligibility for a discretionary variable incentive bonus.
• Comprehensive healthcare coverage: Medical, prescription drug, dental, and vision insurance.
• Retirement planning: Access to a 401(k) retirement plan.
• Paid time off: Personal and family sick time, along with company-paid holidays.
• Parental support: Parental leave benefits.
• Life insurance: Basic life insurance and supplemental life coverage.
• Disability coverage: Short-term and long-term disability benefits.
• Flexible spending and savings accounts: Health Savings Account (HSA), dental and vision spending accounts, and dependent care Flexible Spending Accounts (FSAs).
• Professional development: Tuition reimbursement, learning opportunities, skills development, and certification support.
• Employee referral program: Opportunities to participate in employee referral initiatives.
• Community and workplace engagement: Corporate-sponsored events and community outreach activities.
• Family support: Access to an emergency backup childcare program.
• Remote work flexibility: Full-time remote work from within the United States, with travel of up to 10% as required.

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

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