Sr. Provider Contracting Manager

About the role

The Sr. Provider Contracting Manager is a senior-level, non-supervisory individual contributor responsible for provider network development, strategic provider contracting, and complex contract negotiations across Community Health Choice's provider network. The role identifies opportunities to expand value-based care agreements and alternative payment arrangements for existing and new lines of business, solves complex contracting challenges focused on improving cost and quality performance, negotiates provider agreements, coordinates quality performance and data submission requirements, ensures regulatory compliance, and maintains effective provider relationships. The Sr. Provider Contracting Manager serves as a subject matter expert for provider contracting strategies and collaborates with Provider Engagement, Compliance, Legal, Quality, Finance, Credentialing, Claims, and Network Operations to implement provider agreements, support operational excellence, and achieve departmental and organizational objectives.

Responsibilities

• Negotiate complex contract language and rates with hospital, physician, ancillary, and LTSS providers in accordance with established parameters and guidelines
• Collaborate with Compliance, Legal, Quality, Finance, and Credentialing to finalize provider contracts, amendments, and new agreements
• Ensure compliance with regulatory and product requirements related to provider contracting, including network adequacy standards
• Provide senior-level negotiation support and recommendations for complex, high-impact, or escalated provider agreements
• Lead quality performance monitoring, data submission coordination, and data integrity activities related to clinical quality measures
• Identify opportunities to expand provider networks and value-based provider agreements for existing and new lines of business
• Conduct external meetings with prospective and existing providers to negotiate or renegotiate agreements
• Collaborate with internal teams to assess contracting opportunities and facilitate network expansion efforts
• Ensure compliance with regulatory requirements and product specifications related to provider contracting functions
• Monitor network adequacy and coordinate adjustments needed to meet regulatory standards
• Coordinate with Network Management, Claims, Payment Solutions, Provider Data Integrity, Quality, and other stakeholders to support accurate contract reimbursement, quality reporting, and adherence to requirements
• Identify contract risks, inconsistencies, and implementation concerns and recommend appropriate resolution
• Lead cross-functional implementation activities for complex provider contracts, amendments, alternative payment arrangements, and new agreements
• Analyze and resolve escalated contracting, reimbursement, implementation, and operational issues in partnership with internal stakeholders and providers
• Communicate contract terms, implementation requirements, and operational impacts clearly to affected stakeholders
• Support consistent interpretation and administration of executed provider agreements
• Serve as a senior liaison between Community Health Choice and its providers, facilitating communication and addressing complex or escalated issues
• Maintain productive provider relationships to support contracting, implementation, quality performance, and data submission activities
• Represent Network Management in provider meetings and cross-functional discussions requiring advanced contracting expertise
• Contribute to departmental goals outlined in the annual business plan
• Participate in and support process improvement initiatives that enhance contracting quality, consistency, efficiency, and effectiveness
• Provide technical guidance, contract knowledge, and informal support to Provider Contracting team members without direct supervisory responsibility

Qualifications

• High school diploma or equivalent required. Bachelor's degree in business, Healthcare Administration, Finance, or a related field preferred.
• Six (6) years of progressively responsible provider contracting and contract negotiation experience in healthcare or managed care, including experience with complex provider agreements
• Experience with hospital, physician, ancillary, LTSS, delegated provider arrangements, and alternative payment or value-based agreements
• Advanced managed care contract negotiation experience is required
• Experience within the Houston market and with STAR+PLUS, LTSS, HCBS, Medicare, alternative payment arrangements, clinical quality measures, or value-based contracting preferred
• Microsoft Office, including Word, Excel, and Outlook
• Travel is required approximately 50% of the time. Access to a vehicle and a valid Texas driver's license are required.