Director, Managed Care Contracting - Revenue & Reimbursement - 40hrs

Connecticut Children's • $125K — $150K *
Hartford, CT 06106In-Person
Healthcare
8 - 10 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's degree in Business Administration, Healthcare Management, Accounting, Finance, or related field.
  • 10+ years of progressive experience in managed care contracting.
  • 5+ years in a multi-hospital or health system setting.
  • 5+ years of management and leadership experience.
  • Expertise in contract negotiations with various payers.

Responsibilities

  • Manage and develop a portfolio of managed care contracts for the hospital and outpatient services.
  • Lead contracting strategy, including analysis and negotiation with payers.
  • Review existing payer agreements and recommend contract language improvements.
  • Negotiate provider agreements and payment models for managed care contracts.
  • Conduct contract modeling activities to assess payment methodologies' financial impact.
  • Research and implement value-based care and alternative risk methodologies.
  • Build and maintain relationships with managed care plans to support contract performance.

Benefits

  • Opportunity to influence high-level healthcare contracting strategy.
  • Leadership role within the Finance Leadership Team.
  • Support for professional development and potential for advanced credentialing.
  • Engagement with a mission-driven organization focusing on children's health.
  • Collaboration with multidisciplinary teams across the healthcare system.
Full Job Description
Job Description

The Director, Managed Care Contracting is a senior strategic leader and key member of the Finance Leadership Team, reporting directly to the Chief Financial Officer. This role owns Connecticut Children's managed care contracting function end-to-end-leading payer strategy, contract negotiations, compliance, and payer relationship management across the hospital, outpatient departments, and specialty group. The Director serves as the organization's primary expert on reimbursement strategy and payer economics, translating contract performance into actionable financial insight that supports organizational growth and mission. This is a high-impact leadership role for a strategic operator who can drive contracting outcomes, build lasting payer partnerships, and develop a high-performing managed care team.

Responsibilities

Contracting & Negotiations-30%
  • Directly manage and develop a portfolio of managed care contracts for Connecticut Children's hospital, outpatient departments, and specialty group; serve as the primary contracting lead for all facilities.
  • Lead managed care contracting strategy, including analysis of contract and rate proposals, development of counter-proposal terms, and negotiation meetings with payers.
  • Review all existing payer agreements and recommend alternative contractual language where ambiguous or detrimental terms and provisions exist.
  • Develop and negotiate provider agreements and contractual payment terms for the medical center and affiliate organizations, including developing payment models for facility managed care contracts.
  • Direct contract modeling activities, including what-if analysis using contract modeling tools (e.g., STRATA or equivalent), to assess feasibility of different payment methodologies and utilization patterns and their financial impact on Connecticut Children's.
  • Research and apply global billing payment models, value-based care structures, and alternative risk-based methodologies. Challenge organizational assumptions based on data to drive change and ensure contracting success.
  • Research and develop pay-for-performance models and Episode of Care payment methodologies under ACO or other alternative risk models. Work with Connecticut Children's accountable care organization to coordinate contracting efforts and outcomes beneficial to providers.
  • Monitor market trends and competitive managed care products to develop strategy recommendations; develop strategic pricing within payer agreements that aligns with organizational priorities and growth initiatives.
  • Represent managed care contracting interests in organizational efforts to build integrated networks, partnerships, and value-based arrangements.

Compliance, Regulatory & Reporting-35%
  • Maintain advanced knowledge of third-party regulations (CMS, NCDHHS, DOI, and equivalent Connecticut agencies) for all payers, including governmental and commercial payers; ensure organizational adherence to applicable requirements.
  • Ensure all regulatory, government, and agency data submissions (e.g., CHA, CHCA) related to managed care are completed accurately and on time.
  • Lead the response to audit requests related to managed care contracts and payer-related matters for annual financial statement audits and external or payer audits. When requested, interface with external and third-party auditors; prepare and defend contract questions and challenges.
  • Support government relations and executive leadership in assessing and quantifying Medicaid financial metrics related to managed care policy or reimbursement changes. Make recommendations to help shape Connecticut Children's response to policy or rate changes.
  • Oversee hospital contract loading in Epic and management of hospital payment variances and facility credentialing as they relate to managed care operations. Attend Epic User Group meetings and training as appropriate.
  • Work closely with Finance and Revenue Cycle teams to ensure reported data is reliable and that contract-related information is accurately reflected in financial reporting.

Payer Relations & Performance-35%
  • Build and direct Connecticut Children's relationships with area managed care plans; cultivate lasting partnerships that support organizational goals and contract performance.
  • Develop and maintain payer scorecards to highlight performance strengths and opportunities relative to contract terms. Actively partner with payer representatives to improve both Connecticut Children's performance and payer compliance with contract obligations.
  • Oversee problem solving related to contract terms, payment promptness, payer-member issues, and physician-payer relations.
  • Serve as the primary contact for physicians, Patient Financial Services (PFS), Billing, and Remittance staff for payer-related questions; act as liaison to payers for prompt issue resolution.
  • Act as hospital and specialty group finance liaison during Joint Operating Committee (JOC) meetings with managed care organizations and PFS representatives.

Performs Other Duties as Assigned.

Qualifications

Education and/or Experience Required:
  • Education: Bachelor's degree in Business Administration, Healthcare Management, Accounting, Finance, or a related discipline.
  • Experience:
    • Minimum of 10 years of progressive experience in managed care contracting required.
    • Minimum of 5 years of experience in a multi-hospital or health system setting.
    • At least 5 years of management and leadership experience.

Education and/or Experience Preferred:
  • Education: Master's degree in Business Administration, Healthcare Management, Accounting, Finance, or a related discipline.
  • Experience: Demonstrated experience leading contract negotiations with commercial, Medicaid, and/or government payers in a hospital or health system setting.

License and/or Certification Required:
  • None.

License and/or Certification Preferred:
  • Certified Healthcare Financial Professional (CHFP), Certified Public Accountant (CPA), or Certified Revenue Cycle Representative (CRCR).

Knowledge, Skills and Abilities:

Knowledge:
  • Advanced knowledge of managed care contracting, payer landscape, and reimbursement methodologies for hospital and professional services.
  • Advanced knowledge of third-party payer requirements and state/federal regulations pertaining to hospital and professional reimbursement, including CMS, DOI, and applicable Connecticut regulatory agencies.
  • Working knowledge of value-based care, risk-based contracting models, and alternative payment methodologies (e.g., ACOs, Episodes of Care, Pay-for-Performance).
  • Advanced knowledge of healthcare finance, budgeting, and fiscal management concepts.
  • Advanced knowledge of reporting systems and database structures to interpret and leverage contract performance data.
  • Advanced knowledge of Epic contract management, contract loading, and proration functions.
  • Working knowledge of contract modeling tools (e.g., STRATA or equivalent).

Skills:
  • Proficiency in Microsoft Office Suite; working knowledge of Microsoft Windows operating system.
  • Advanced verbal and written communication skills; ability to present effectively to small and large groups.
  • Exceptional interpersonal skills and ability to interact effectively with medical center leadership, government agencies, physicians, and third-party payers.
  • Skill in evaluating operations and procedures, formulating policy, and developing and implementing new contracting strategies.
  • Experience with Epic and contract management tools.

Abilities:
  • Accept responsibility for and direct all managed care department activities with a high degree of accountability and ownership.
  • Delegate tasks appropriately and maximize value by focusing on high-impact strategic initiatives.
  • Exercise independent judgment and manage sensitive information across a range of internal and external stakeholders.
  • Organize resources, establish priorities, and develop and implement short- and long-range goals.
  • Persuade and influence others through data-driven analysis and relationship-driven leadership.
  • Foster a cooperative and high-performing work environment.
  • Ensure quality outcomes and drive continuous improvement of contracting processes and workflows.


About Connecticut Children's

Connecticut Children's Careers

There has never been a better time to explore the job opportunities at Connecticut Children's, a leading pediatric healthcare system. As a beacon of innovation and leadership in child health, Connecticut Children's offers a range of career paths for professionals passionate about making a difference in the lives of children.

Work You’ll Do

Join Connecticut Children's dynamic team to contribute to a mission-driven environment where the health and well-being of children come first. The company stands at the forefront of pediatric healthcare, combining clinical expertise with compassionate care. Professionals at Connecticut Children's lead the way in pediatric medicine, not only by providing exceptional care but also by advancing the field through research and innovation. The team's dedication to growth and learning ensures that every member has the opportunity to expand their skills and advance their career.

Explore Job Opportunities and Internships

Connecticut Children's offers a variety of positions and internships that cater to a wide range of professional skills and interests. From clinical roles to administrative positions, the company is always looking for dedicated individuals to join their team.

Innovative Work Environment

Connecticut Children's fosters an environment of innovation where team members from diverse backgrounds bring their unique perspectives to solve challenges. This collaborative atmosphere is pivotal for developing solutions that enhance patient care and operational efficiency.

Commitment to Diversity and Professional Development

The commitment to diversity and professional development at Connecticut Children's is evident through comprehensive diversity training programs and leadership development opportunities. These initiatives ensure that all team members are equipped to lead, innovate, and grow within the company.

Benefits and Culture

Employees at Connecticut Children's enjoy a supportive culture that values work-life balance, along with a competitive benefits package that supports both personal and professional growth. The company's culture is built on a foundation of respect, integrity, and a shared commitment to improving the lives of children.

Join the Team

Connecticut Children's is actively hiring and encourages interested candidates to apply. Prospective team members are invited to explore open positions that match their skills and interests. The hiring process at Connecticut Children's is designed to be transparent and engaging, starting from the initial application to the interview and eventual onboarding.

Stay Connected

Stay informed about new job opportunities, company updates, and industry insights by joining Connecticut Children's professional network. Engaging with Connecticut Children's through various networking events can provide valuable connections and insights into the company's operations and culture.

Career Advancement

With a strong emphasis on career advancement, Connecticut Children's supports its employees through ongoing training, mentorship, and access to cutting-edge resources. Whether you are just starting your career or looking to take it to the next level, Connecticut Children's provides the tools needed to succeed in a competitive healthcare environment.

Apply Today

Ready to make a significant impact in pediatric healthcare? Review the list of available positions, tailor your resume, and prepare for a rewarding journey at Connecticut Children's. Discover how your expertise can contribute to a healthier future for children.

SEARCH CONNECTICUT CHILDREN'S JOBS

Keep Up to Date

For career tips, success stories, and a deeper look into the life-changing work at Connecticut Children's, read the Careers Blog. Gain insights that can help propel your career forward in pediatric healthcare.

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