Contract Manager

Brighton Health Plan Solutions, LLC (BHPS) is seeking a Contract Manager to handle contracting and relationship maintenance with network health systems in the New York metro market. This role focuses on recruiting and managing provider networks, including hospitals and physician groups, while ensuring cost-effective and competitive arrangements. The position is hybrid and can be based in our Long Island office.

Responsibilities

• Review, analyze, negotiate, implement, and maintain existing contracts with an understanding of professional rate schedules and contractual language.
• Identify network development opportunities through financial analysis, client requests, and product development.
• Define and pursue performance improvement opportunities.
• Implement strategic contract initiatives, including alternative payment methodologies such as bundling, value-based payment, and pay-for-performance.
• Analyze reports on cost, utilization, claim submission patterns, and outcomes; prepare presentations on findings.
• Develop, implement, and support efforts to build new network solutions and deploy them as appropriate.
• Assist in resolving provider issues through root cause analyses, mediation, and strategic evaluation.
• Partner with internal teams on outstanding payments, medical management, and provider policy.
• Perform other duties and projects as assigned by supervisors in line with department and company needs.

Requirements

• Minimum 5 years in a provider or hospital administration role.
• Strong understanding of contract language and healthcare contracting.
• Sound knowledge of professional provider cost structures and reimbursement methodologies.
• Demonstrated analytical and negotiation abilities, with excellent communication and presentation skills.
• Ability to multi-task, with strong organizational and customer service skills.
• Proficiency in Excel.

Preferred Qualifications

• 5 years in a provider contracting role with existing market relationships in the New York metro area.
• Experience in financial or actuarial modeling.
• Expert proficiency in Excel; SQL and Access experience.
• Understanding of provider experience, clinical operations, and revenue cycle management.
• Master’s Degree.

About Brighton Health Plan Solutions

Brighton Health Plan Solutions, LLC is committed to improving how healthcare is accessed and delivered. Our culture emphasizes encouragement, respect, diversity, inclusion, and belonging. We partner with self-insured employers, Taft-Hartley Trusts, health systems, providers, and other TPAs to solve today’s healthcare challenges through flexible, cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, proprietary provider networks, and an innovative technology platform. Together with our partners, we transform the health plan experience by aligning incentives and unlocking opportunities for enhanced member experiences, improved health outcomes, and achieving healthcare goals.