Managed Care Contracting Manager

Job Summary

The Managed Care Resource will support leaders in Home Health, Hospice, Private Duty and Senior Living Facility operations in managed‑care contracting and revenue enhancement strategies for all healthcare payers, while assisting in preparation for industry changes.

• Negotiate managed‑care payer contract rates and terms; provide guidance on development of managed‑care relationships; ensure timeliness and appropriateness of negotiated rates.
• Negotiate contracts for new locations, manage contract terminations, conduct managed‑care education sessions, and develop a strategic vision to accelerate results.
• Engage in complex levels of contract development and negotiation with managed‑care payors, including managed‑care organizations, ACOs, health systems, hospitals, physician organizations, and third‑party administrators.
• Work with Legal and Finance teams to analyze margins based on costs and rates for existing and newly acquired operations.
• Plan, direct, and evaluate tactical plans that ensure expansion and support of business operations into managed‑care relationships while optimizing financial performance and minimizing risk.
• Assist in analysis of contract terms and rates; coordinate submissions of amendments, reimbursement changes, and language changes; advise operations of risks and advantages of signing contracts.
• Identify, develop, and maintain effective relationships with managed‑care payors and regulatory agencies.
• Provide guidance and training to Field Operations partners to accelerate field results.
• Monitor industry changes, market trends, and events to identify opportunities to increase and protect managed‑care revenue.
• Coordinate and assist each operation with contract cancellations, denials, and appeals.
• Serve as an internal managed‑care subject‑matter expert to Presidents, Executive Directors, and Service Center leadership.
• Teach, train, and advise operational leadership on administering managed‑care contracts; create and distribute tools, training, and resources for leadership, AR teams, intake personnel, case management, and other staff.
• Assist the AR team with high‑level managed‑care claims issues and projects to ensure timely collection of monies due.
• Serve as the primary liaison distributing key contract terms and rates for all new and existing managed‑care payer contracts.

• Bachelor’s degree in business administration, management, or health‑care administration (preferred).
• Minimum of 5 years’ experience in managed‑care contracting with a payer or provider organization.
• Analytically oriented with the ability to communicate complex financial matters concisely and professionally.
• Knowledge of Medicare Advantage, Commercial and Managed Medicaid products (HMO, PPO, EPO, POS, Special Needs Plans), ACOs, and value‑based purchasing strategies.
• Understanding of managed‑care payer contract language, terms, standard requirements, and negotiated rate methodology.
• Strong prioritization, planning, and multitasking skills with keen attention to detail and analytical problem‑solving abilities.
• Excellent verbal and written communication skills and critical‑thinking abilities.
• Ability to maintain confidentiality and comply with HIPAA.
• Knowledge of Home Health, Hospice, Private Duty, and Assisted Living Facility operations (plus).
• Flexibility, adaptability, and ability to work in a rapidly changing environment.
• Knowledge of CPT‑4, HCPCS, Revenue, and ICD coding.
• Strong computer skills (MS Word, Outlook, Excel) and Smartsheet knowledge (plus).
• Ability to travel as required.

Location: Remote

Compensation: $95,000 - $105,000

We are an equal opportunity employer committed to ensuring that all conditions and privileges of employment—including recruitment, hiring, evaluation, promotion, and termination—are based on qualifications and work record. No employment decision is made on the basis of race, color, religion, creed, sex, pregnancy, sexual orientation, gender identity or expression, age, national origin, ancestry, citizenship, veteran status, or disability.