Director, Managed Care Contracting - Revenue & Reimbursement

Job Description
Connecticut Children’s is one of the nation’s leading pediatric health systems, dedicated to improving the health and well‑being of children across Connecticut and beyond. The Director, Managed Care Contracting is a senior strategic leader and key member of the Finance Leadership Team, reporting directly to the Chief Financial Officer. This role owns Connecticut Children’s managed care contracting function end-to-end—leading payer strategy, contract negotiations, compliance, and payer relationship management across the hospital, outpatient departments, and specialty group.

The Director serves as the organization’s primary expert on reimbursement strategy and payer economics, translating contract performance into actionable financial insight that supports organizational growth and mission. This is a high-impact leadership role for a strategic operator who can drive contracting outcomes, build lasting payer partnerships, and develop a high-performing managed care team.

Job Description
Connecticut Children’s is one of the nation’s leading pediatric health systems, dedicated to improving the health and well‑being of children across Connecticut and beyond. The Director, Managed Care Contracting is a senior strategic leader and key member of the Finance Leadership Team, reporting directly to the Chief Financial Officer. This role owns Connecticut Children’s managed care contracting function end-to-end—leading payer strategy, contract negotiations, compliance, and payer relationship management across the hospital, outpatient departments, and specialty group.

The Director serves as the organization’s primary expert on reimbursement strategy and payer economics, translating contract performance into actionable financial insight that supports organizational growth and mission. This is a high-impact leadership role for a strategic operator who can drive contracting outcomes, build lasting payer partnerships, and develop a high-performing managed care team.

• Directly manage and develop a portfolio of managed care contracts for Connecticut Children’s hospital, outpatient departments, and specialty group; serve as the primary contracting lead for all facilities.
• Lead managed care contracting strategy, including analysis of contract and rate proposals, development of counter-proposal terms, and negotiation meetings with payers.
• Review all existing payer agreements and recommend alternative contractual language where ambiguous or detrimental terms and provisions exist.
• Develop and negotiate provider agreements and contractual payment terms for the medical center and affiliate organizations, including developing payment models for facility managed care contracts.
• Direct contract modeling activities, including what-if analysis using contract modeling tools (e.g., STRATA or equivalent), to assess feasibility of different payment methodologies and utilization patterns and their financial impact on Connecticut Children’s.
• Research and apply global billing payment models, value-based care structures, and alternative risk-based methodologies. Challenge organizational assumptions based on data to drive change and ensure contracting success.
• Research and develop pay-for-performance models and Episode of Care payment methodologies under ACO or other alternative risk models. Work with Connecticut Children’s accountable care organization to coordinate contracting efforts and outcomes beneficial to providers.
• Monitor market trends and competitive managed care products to develop strategy recommendations; develop strategic pricing within payer agreements that aligns with organizational priorities and growth initiatives.
• Represent managed care contracting…