Contracts Manager - Payor, MCO, and Medicaid Focus

Key Responsibilities

• Participates in contract negotiations with payors, MCOs, Medicare Advantage, and government programs in partnership with sales.
• Coincide internally with legal, finance, compliance, and business development teams to ensure contracts align with organizational strategy.
• Maintain a repository of executed contracts and track key terms, renewal dates, and deliverables.
• Monitor ongoing compliance with contract terms and assist in resolving disputes or audits.
• Partner with product and commercial teams to support market access strategies.

Requirements

• Contracts Management Experience: 5–8+ years of progressive experience managing healthcare-related contracts.
• Proven track record negotiating, drafting, and managing payor, MCO, and Medicare Advantage agreements.
• In-depth knowledge of Medicare and Medicaid programs, reimbursement methodologies, and regulatory frameworks.
• Familiarity with value-based care, capitation models, and fee-for-service contracts.
• Healthcare Industry Expertise: Direct experience in healthcare contracting, ideally with health plans, provider networks, or healthcare technology companies.
• Knowledge of CMS guidelines, HIPAA compliance, and state Medicaid regulations.
• Understanding of Medicare Advantage, MCO’s, including Stars, CAHPS, and risk adjustment programs.
• Project Management Capabilities: Ability to lead cross-functional contract implementation projects from initiation through execution.
• Experience developing timelines, managing stakeholders, and reporting status to leadership.
• Proficiency in project management tools (e.g., Jira, Asana, MS Project, or similar).
• Technical & Analytical Skills: Strong understanding of contract lifecycle management.
• Proficient in Excel and legal/financial modeling related to reimbursement or contract terms.
• Ability to analyze and interpret legal and financial risk in contract terms.

Education & Certifications

• Bachelor's degree required; JD, MBA, or Master’s in Health Administration (MHA) preferred.
• Certification in Contract Management (e.g., CCCM, CPCM, or PMI-PMP) is a plus.

Soft Skills & Communication

• Excellent communication and negotiation skills.
• Strong attention to detail and risk mitigation mindset.
• Ability to work autonomously and collaboratively in a fast-paced, innovative environment.

Nice to have

• Understanding of elder care markets, digital health, or assistive robotics.
• Familiarity with AI-enabled healthcare solutions or remote care delivery models.
• Experience working with Medicare Advantage, Medicaid, or Dual Eligible Special Needs Plans (D-SNPs).