Manager of Managed Care OperationsLooking to elevate your career? Join us!
Work Location: Hybrid
Work Hours: Full time, business hours
The Manager of Managed Care Operations is a high-accountability role serving as the operational backbone of the Managed Care function. This individual acts as the central program manager and coordinator for all managed care initiatives, ensuring seamless coordination from contract negotiation through operational implementation and paid claims.
This role bridges strategy and execution. Once a payer agreement is negotiated, the Operations Manager owns the end-to-end transition into live operations - aligning Legal, Revenue Cycle, Credentialing, Clinical Leadership, and Technology teams to ensure contracts are accurately built, activated, and performing as intended.
Success in this role requires exceptional organization, contract fluency, cross-functional leadership, and the ability to proactively remove barriers that delay implementation or impact reimbursement.
Department Highlights: - Highly engaged culture.
- Collaborative team environment
- Fast-paced and Growth-Oriented
Here is what you will need:- 3+ years of experience in Managed Care, Revenue Cycle Management, or Payer Contracting.
- Demonstrated experience supporting contract implementation or payer enrollment processes.
- Bachelor's degree in healthcare administration, Business Administration, Finance, or a related field required; equivalent combination of education and relevant experience will be considered.
- Working knowledge of payer enrollment workflows, credentialing, billing system configuration, and claim adjudication processes.
- Ability to interpret contract language and translate financial terms into operational requirements.
- Proficiency in Excel and data management; experience working with healthcare systems (EMR, PM, billing platforms).
- Strong project management skills with the ability to manage multiple concurrent initiatives.
- Exceptional organizational skills and attention to detail.
- Independent problem-solving with appropriate escalation judgment.
- Ability to influence without authority across cross-functional teams.
A Day in the Life of a Manager of Managed Care Operations:- Program & Project Management
- Develop and maintain a centralized Managed Care Master Project Tracker covering contract negotiations, renewals, expansions, compliance deadlines (e.g., MIPS), and recurring reporting obligations.
- Establish clear timelines, ownership, and accountability across departments.
- Proactively identify bottlenecks and escalate risks that could delay operational readiness or revenue realization.
- Drive projects to completion with measurable outcomes.
- Contract Lifecycle Management
- Own the administrative transition of negotiated agreements into operational execution.
- Translate contract rates, terms, carve-outs, and provisions into actionable build instructions for Revenue Cycle and system teams.
- Ensure contract terms are accurately reflected in billing systems, payer setups, and reimbursement logic.
- Confirm readiness prior to go-live and monitor initial claims performance post-implementation.
- Payer Enrollment & Network Expansion
- Coordinate addition of new locations, Tax Identification Numbers (TINs), and providers to existing payer agreements.
- Manage ownership letters, roster submissions, and payer documentation for both commercial and government plans.
- Track and confirm payer approvals and effective dates to prevent reimbursement disruption.
- Maintain accurate provider and location alignment across all payer contracts.
- Cross-Functional Liaison & Implementation Leadership
- Serve as the primary operational liaison between Managed Care, Legal, Revenue Cycle, Credentialing, Clinical Leadership, and IT.
- Ensure new agreements are fully operationalized across systems (EMR, practice management, clearinghouse, billing platforms).
- Lead internal communication of contract changes and implications.
- Facilitate resolution of implementation gaps that impact revenue or patient access.
- Payer Plan Build & Data Integrity
- Extract and translate contract data into structured rate tables and build documentation.
- Coordinate creation and maintenance of insurance plans ("iplans") within applicable technologies.
- Ensure alignment between negotiated terms, system configuration, and billing outputs.
- Maintain a master database of payer contracts, rate structures, and effective dates.
- Issue Resolution & Performance Support
- Triage and research managed care inquiries, including in/out-of-network status, excluded products, and reimbursement discrepancies.
- Investigate patient leakage and payer denials related to contract misalignment.
- Escalate systemic issues impacting reimbursement or network status.
- Support reporting and closeout activities, including MIPS and charity reporting coordination.
