Department:13385 Enterprise Corporate - Managed Health Payor Contracting
Status:Full time
Benefits Eligible:Yes
Hours Per Week:40
Schedule Details/Additional Information:Responsbile for payor contracting primarily for Advocate Health WI providers.
Pay Range:$99.75 - $159.60
Major Responsibilities:- Lead development and execution of payer contracting strategies across assigned markets, payers, and portfolio scope, including recommendations on payer participation, network positioning, and contract optimization opportunities.
- Serve as primary owner of payer relationships, aligning engagements with enterprise strategy and priorities.
- Lead and oversee negotiation and renegotiation of fee-for-service and value-based contracts, including complex risk-based arrangements, across a diverse portfolio of 20+ provider types spanning acute, post-acute, and clinically integrated networks.
- Ensure contract terms, rates, and structures meet financial, operational, and compliance expectations.
- Develop and execute negotiation strategies, including financial modeling and positioning.
- Lead bundled payment arrangements and contracting with independent providers participating in bundled services (e.g., transplant and other specialty programs), ensuring alignment with financial, operational, and legal requirements.
- Partner with internal divisions/areas including but not limited to revenue cycle, operations, and contract administration teams to ensure accurate implementation and ongoing integrity of contracts.
- Monitor and manage portfolio performance, including financial modeling, risk assessment, and development of recommendations to support decision-making across revenue, margin, reimbursement, and payer mix.
- Translate market trends, payer dynamics, and regulatory changes into actionable contracting strategies.
- Lead and develop high-performing teams while influencing cross-functional stakeholders across the organization.
- Perform other duties as assigned.
Education Required:- Bachelor's Degree in Business, Healthcare Administration, Finance, Economics, or related field required.
- Master's Degree (MBA, MHA, or equivalent) preferred.
Work Experience Required:- Minimum of 8 years of professional experience, with at least 5 years in payer contracting, managed care, healthcare financial strategy, or related fields, with demonstrated progressive responsibility.
- Demonstrated success leading complex contract negotiations and achieving financial performance targets.
- Experience across commercial, Medicare Advantage, Medicaid, and value-based payment models preferred.
- Experience in large, integrated health systems or multi-entity provider organizations preferred.
Knowledge, Skills & Abilities Required:- Strong expertise in payer contracting, reimbursement methodologies, and value-based care models.
- Advanced financial and analytical capabilities, including contract modeling and performance evaluation.
- Strong negotiation, influencing, and relationship management skills.
- Ability to synthesize complex information and translate into strategic recommendations.
- Effective communication and executive presence with ability to engage stakeholders at all levels.
- Demonstrated ability to lead teams and operate effectively in complex, matrixed environments.
Physical Requirements and Working Conditions:- Primarily operates in a standard office environment with periodic travel.
- Requires extended periods of sitting, with occasional standing, walking, and travel.
- Requires effective verbal and written communication with internal and external stakeholders.
- Visual and auditory acuity required, with or without assistive devices.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
Our Commitment to You:Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:
Compensation- Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift, on call, and more based on a teammate's job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
Benefits and more- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.
