Managed Care Manager

Managed Care Manager

Location: Remote (U.S.)
Department: Revenue Cycle Management
Reports To: Director of Managed Care

Are you an experienced managed care professional who thrives on building payer partnerships, negotiating contracts, and improving reimbursement outcomes? We're looking for a Managed Care Manager to play a key role in advancing our payer strategy and supporting the continued growth of our organization.

In this role, you'll collaborate with leaders across Managed Care, Revenue Cycle, Operations, Finance, and Legal to ensure our providers and services remain accessible to patients through strong payer relationships and operational excellence. From contract negotiations and reimbursement analysis to provider enrollment and EDI operations, you'll help optimize processes that directly impact patient access and organizational success.

This is an exciting opportunity for a strategic, detail-oriented professional who enjoys solving complex challenges, driving process improvements, and influencing business outcomes in a dynamic healthcare environment.

• Lead and support payer contracting activities, including new agreements, renewals, amendments, network expansions, Letters of Agreement (LOAs), Single Case Agreements (SCAs), and contract maintenance.
• Negotiate reimbursement rates and evaluate fee schedules, contract language, and payer policies.
• Manage contract life cycles, maintaining accurate records of agreements, participation requirements, and payer communications.
• Support organizational growth initiatives by facilitating payer participation for new providers, locations, and markets.

• Analyze fee schedules, reimbursement methodologies, and payer policies to identify opportunities for improved financial performance.
• Partner with Revenue Cycle and Operations teams to investigate and resolve underpayments, rate discrepancies, and reimbursement issues.
• Monitor payer performance and support initiatives that improve reimbursement accuracy and revenue capture.

• Support provider credentialing and enrollment activities, including payer affiliations, roster management, demographic updates, and participation tracking.
• Assist with EDI and payer operations such as claims, eligibility, ERA, EFT, clearinghouse enrollments, payer IDs, and troubleshooting payer connectivity issues.
• Collaborate on provider onboarding and operational implementations affecting payer participation.

• Serve as a key contact for payer-related issues and escalations.
• Partner with internal stakeholders on system implementations, process improvements, and managed care initiatives.
• Stay informed on Medicare, Medicaid, commercial payer, and regulatory changes, communicating key impacts and recommendations to leadership.
• Support departmental reporting, strategic planning, and special projects led by the Director of Managed Care.

• Bachelor's degree in Healthcare Administration, Business, or a related field preferred.
• 3-5 years of progressive experience in managed care, payer contracting, healthcare reimbursement, or payer operations.
• Strong knowledge of commercial payers, Medicare Advantage plans, Medicaid managed care organizations (MCOs), government plans, and third‑party administrators (TPAs).
• Experience negotiating contracts and managing fee schedules and reimbursement arrangements.
• Familiarity with EDI processes, ERA and EFT enrollments, and payer operational workflows.
• Working knowledge of medical coding and claims processing, including CPT, HCPCS, and ICD-10.
• Strong communication, negotiation, relationship management, and analytical skills.
• Proficiency with Microsoft Office and contract management or payer-related systems.

• Experience in behavioral health, provider-based contracting, or physician practice managed care operations.
• Knowledge of value‑based reimbursement models and emerging payer trends.
• Experience partnering with Finance, Revenue Cycle, and…