Contract Manager

Brighton Health Plan Solutions (BHPS) is seeking a Contract Manager to handle contracting and relationship maintenance with network health systems in the New York metro market. This role involves recruiting and managing providers, including hospitals and physician groups, while ensuring cost-effective and competitive arrangements. The Contract Manager will coordinate strategic provider network development and bring an analytic mindset to discussions.

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 (e.g., bundling, value-based payment, pay-for-performance).
• Analyze reports on cost, utilization, claim submission patterns, and outcomes; prepare presentations on findings.
• Develop, implement, and support new network solutions.
• Assist in resolving provider issues through root cause analyses, mediation, and strategic relevance assessments.
• Partner with internal teams on outstanding payments, medical management, and provider policy.
• Perform additional duties and projects as assigned by supervisors.

Requirements

• Minimum 5 years in a provider or hospital administration role.
• Strong understanding of contract language and healthcare contracting.
• 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.
• 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 partners with self-insured employers, Taft-Hartley Trusts, health systems, providers, and other TPAs to deliver flexible, cutting-edge third-party administration services. With decades of health plan management expertise, proprietary provider networks, and an innovative technology platform, BHPS transforms the health plan experience by enhancing member experiences, improving health outcomes, and achieving client goals.

This is a hybrid position based in the Long Island office.