Manager Managed Care Contracting

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary 

The Manager – Managed Care Contracting supports the development, negotiation, implementation, and management of managed care payer agreements for hospital and physician services. This role collaborates with facility leadership, revenue cycle, physician services, and corporate stakeholders to ensure contracts align with organizational financial and operational objectives. The Manager is responsible for LOA contract analysis, negotiation support, payer relationship management, and monitoring contract performance to optimize reimbursement and patient access.

Essential Functions

• Support negotiation and execution of managed care LOA agreements across commercial, Medicare Advantage, and Medicaid payers
• Analyze contract terms, reimbursement methodologies, and financial impact of proposed agreements
• Develop financial models, rate comparisons, and revenue projections to support negotiation strategy
• Maintain and update contract documentation, payer matrices, and reimbursement schedules
• Monitor contract performance and identify opportunities for renegotiation or improvement
• Collaborate with Revenue Cycle, Case Management, and Patient Access teams to ensure alignment with payer requirements
• Assist with implementation of new or amended contracts, including stakeholder communication and education
• Support resolution of payer issues, including underpayments, denial trends, and contract interpretation questions
• Maintain payer relationships and serve as a point of contact for contract-related matters
• Review contract language and coordinate with legal counsel as needed
• Prepare reports, presentations, and summaries for leadership on contract performance and strategy
• Ensure compliance with regulatory requirements and organizational policies
• Participate in special projects and strategic initiatives as assigned

Knowledge / Skills / Abilities / Expectations

• Knowledge of healthcare reimbursement methodologies (e.g., DRG, per diem, case rates, fee schedules)
• Understanding of managed care contract structures and payer operations
• Strong analytical and financial modeling skills
• Ability to interpret complex contract language and reimbursement terms
• Strong business acumen and negotiation support capabilities
• Excellent written, verbal, and presentation skills
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment
• Proficiency in Microsoft Excel, Word, and PowerPoint
• Ability to work independently and collaboratively across departments
• Strong attention to detail and problem-solving skills

Education

• Bachelor’s Degree in Business, Healthcare Administration, Finance, or related field (preferred)

Licenses / Certifications

• None specified

Experience

• 5+ years healthcare experience (required)
• 3+ years of experience in managed care contracting, reimbursement, or related financial analysis (required)
• Prior experience with hospital and/or physician payer contracting (preferred)