Supervisor, Provider Contracts

General Description

This role functions as a hands-on manager and primary escalation point for complex negotiations, regulatory interpretation, and financial risk assessment, while actively supporting day-to-day contracting work. In addition to directly contributing to negotiations and issue resolution, the role drives standardization, performance management, and continuous operational improvement within the contracting function. It requires a leader with deep subject-matter expertise, sound judgment, and the ability to balance strategic direction with practical execution.

Qualifications

• Bachelor’s degree in healthcare administration, public policy, business, law, or a related field required; three (3) years of progressive provider contracting experience in a managed care or health plan environment, including supervisory experience.
• Master’s degree (MBA, MPH, MHA) highly desirable.

Skills

• Advanced contract negotiation, drafting, redlining, and financial impact analysis across complex provider arrangements.
• Advanced ability to evaluate reimbursement methodologies, rate strategies, and total cost of care impacts.
• Intermediate leadership skills in supervising, coaching, and developing experienced contract management professionals.
• Intermediate skills in interpreting and operationalizing complex regulatory requirements from DHCS, CMS, and DMHC.
• Intermediate proficiency with contract management systems, financial models, and Microsoft Office applications (Excel, Word, Outlook, Teams).

Knowledge

• Extensive knowledge of Medi-Cal and Medicare managed care regulations, provider billing practices, and payment systems.
• Extensive knowledge of reimbursement methodologies, provider incentive structures, and audit readiness requirements.
• Working knowledge of provider performance measurement, including the use of claims, utilization, and financial data to evaluate contract value and network performance.
• Working knowledge of IT configuration workflows applied to claims, utilization, and financial data for assessing contract value, network performance, and audit readiness.

Abilities

• Demonstrated ability to independently lead complex negotiations and interpret regulatory and financial risks.
• Demonstrated ability to use claims data to project rate increases, assess cost impact, and support decision-making.
• Ability to translate strategic objectives into team priorities and performance standards while contributing to strategic initiatives and improvement of contracting operations.
• Ability to communicate and problem-solve effectively with internal and external stakeholders.

Duties & Responsibilities

Leading People

• Develop, manage, and lead a team of self-accountable professionals by modeling real, personal accountability and instilling a culture of psychological safety and accountability.
• Conduct one-on-one conversations with direct report(s), focused on performance, development, and career growth.
• Ensure compliance with labor laws/regulations, support the implementation of organizational policies and procedures, and foster a positive and inclusive culture.
• Support the development, implementation, and monitoring of the department budget, to ensure efficient resource allocation and compliance with policies.

Delivering Results

• Provide strategic oversight of provider contract negotiations, ensuring alignment with financial, regulatory, and network objectives.
• Review and approve high-impact contracts, amendments, and rate changes, ensuring appropriate risk mitigation and documentation.
• Oversee analysis of claims, utilization, and financial data to support reimbursement strategies and executive decision-making.
• Execute, implement, and maintain accurate provider agreements timely.

Leading Change

• Drive continuous improvement of contracting workflows, standards, and templates.
• Lead initiatives to enhance contract management systems, data integrity, and reporting.
• Translate regulatory changes into actionable guidance, tools, and processes for the team.
• Lead change management efforts to ensure adoption of new processes, technologies, and performance expectations.

Building Coalitions

• Serve as a primary contracting liaison across organizational stakeholders.
• Represent the contracting function in cross-functional forums, audits, and strategic initiatives.
• Partner with internal stakeholders to resolve complex provider disputes, escalations, and operational challenges.
• Build and maintain effective relationships with provider organizations to support long-term network stability and collaboration.