Manager of Payor and Market Strategy

Under the supervision of the Director of Managed Care, this role leads the negotiation and renegotiation of contracts with managed-care companies and health plans that account for 70% of the health-system’s revenue.

Responsibilities

• Develop and execute negotiation strategies for managed-care contracts to meet the health-system’s financial and market-share goals.
• Monitor market trends and payer behavior to protect and enhance the health-system’s market position.
• Design and evaluate contract structures—hospital, physician, ASC, bundled, value-based, capitative, etc.—and educate internal stakeholders on their implications.
• Analyze contract terms, special provisions, and rate proposals using tools such as EPIC contract modeling, Excel, and Access; consult with legal counsel as needed.
• Lead payer meetings, prepare negotiation agendas, and represent the health-system in joint operating committee sessions.
• Ensure contract language is financially and operationally sound while remaining compliant with regulations.
• Track contract performance, identify compliance issues, and resolve disputes with internal teams.
• Coordinate across all entities on behalf of the contracting team.
• Analyze historical utilization and revenue trends to flag unexpected contract-performance changes.
• Engage payers proactively to prevent exclusion or disadvantage as payer policies evolve.
• Develop standard and ad-hoc reports for budgeting, revenue projections, and long-range planning.
• Serve as liaison between Revenue Cycle, HITS, and other operational departments to interpret contract language and intent.
• Maintain and update managed-care contracts, payer portals, and EPIC reimbursement models.
• Communicate contract renewals, amendments, and changes to the appropriate audiences.
• Oversee credentialing and re-credentialing for facility and professional services.
• Build and sustain relationships with physicians, administrators, health plans, senior leaders, and external partners.
• Participate in committees, work groups, and strategic initiatives.
• Support Strategic Healthcare Solutions (SHS) recruitment and business development by:
  • Facilitating onboarding and implementation of purchased services.
  • Marketing the SHS value proposition to prospective hospital CEOs and CFOs.
  • Partnering with business leads to resolve customer concerns.
  • Assisting with the integration of new service offerings.
• Manage value-based initiatives:
  • Analyze population, quality, and efficiency data to assess performance in current and proposed value-based models.
  • Collaborate with ambulatory and hospital quality teams to ensure network performance meets or exceeds targets.
  • Develop standard reporting on historical and projected financial outcomes for value-based initiatives.
  • Serve as department liaison between contracting, payers, and clinical operations.

Requirements

• Bachelor’s degree in Business Administration, Healthcare Administration, or a related field from an accredited institution, or equivalent work experience.
• Four or more years of experience in a healthcare organization or health-industry role focused on finance, contracting, or technical analytics.

Preferred Qualifications

• Master’s degree in Business Administration, Healthcare Administration, or a related field.
• Experience in a large healthcare organization or academic medical center in managed-care contracting or financial modeling/analytics.

Time Type: Full time
Location: Southlake Campus