Contract Manager

Contract Manager

We need hope-bringers and changemakers - because the work we all do matters. Join a team that shows up for each other as much as we show up for our clients. At Gaudenzia, your purpose fuels progress - for yourself and others.

Gaudenzia's Mission is to promote long-term recovery by providing comprehensive treatment and support to people with substance use disorder, co-occurring mental health disorders, and related conditions, regardless of individual circumstances.

The Contract Manager is responsible for directing, developing, negotiating, and managing contractual relationships with managed care organizations, commercial insurance carriers, county agencies, governmental entities, and other strategic partners. This position leads contract strategy, rate negotiations, value-based payment initiatives, contract execution, compliance oversight, and ongoing payer relationship management to support organizational growth, financial performance, and operational excellence.

The Contract Manager serves as the organization's subject matter expert on managed care and commercial contracting, ensuring that agreements align with organizational objectives, regulatory requirements, reimbursement goals, and industry best practices. This role also oversees provider enrollment, licensing documentation, contract compliance, and auditing activities to ensure accuracy and adherence to applicable federal, state, and local regulations.

Essential Functions, Duties & Responsibilities

Leadership & Strategy

• Provide executive leadership and direction to non-clinical facility and/or support staff: drivers, food services, maintenance, etc.
• Develop and implement regional strategies aligned with organizational goals and regulatory standards
• Collaborate with senior leadership to drive growth, service expansion, and program development
• Foster a culture of clinical excellence, accountability, and continuous improvement

Contract Strategy and Management

• Develop, implement, and maintain long-term managed care and payer contracting strategies that support organizational goals and financial sustainability.
• Direct and facilitate contractual relationships with managed care organizations, commercial insurance carriers, counties, governmental agencies, and other third-party entities.
• Review, analyze, and interpret contract language, reimbursement methodologies, terms and conditions, and financial implications.
• Identify opportunities for contract optimization, reimbursement enhancement, network expansion, and operational efficiencies.
• Monitor contract performance and recommend strategic modifications to improve outcomes and address changing market conditions.
• Maintain a comprehensive contract repository and tracking system to ensure timely renewals, amendments, and compliance monitoring.

Negotiation and Value-Based Contracting

• Lead negotiations for reimbursement rates, fee schedules, value-based reimbursement arrangements, risk-sharing agreements, and other contractual terms.
• Prepare financial analyses and modeling to support contract negotiations and evaluate reimbursement impacts.
• Collaborate with executive leadership, finance, operations, and clinical departments to establish negotiation objectives and priorities.
• Initiate, negotiate, and execute managed care, commercial, and governmental contracts and contract amendments.
• Evaluate and develop value-based care opportunities and alternative payment models that align with organizational objectives.
• Monitor contract performance metrics and value-based program outcomes to ensure contractual obligations are met.

Relationship Management

• Serve as the primary liaison between the organization and managed care organizations, commercial payers, counties, and other contracted entities.
• Develop and maintain effective working relationships with payer representatives and key external stakeholders.
• Coordinate and facilitate issue resolution related to claims processing, reimbursement disputes, credentialing concerns, contract interpretation, and operational challenges.
• Represent the organization during payer meetings, negotiations, and strategic partnership discussions.
• Ensure ongoing communication and collaboration with internal departments regarding payer requirements and contract performance.

Regulatory Compliance and Risk Management

• Ensure all contracts comply with federal, state, local, and industry regulations, including applicable healthcare and payer contracting requirements.
• Monitor regulatory changes and assess impacts on existing and proposed contracts.
• Review and audit contractual documents to identify compliance risks and recommend corrective actions.
• Collaborate with legal counsel and compliance teams regarding contract interpretation, risk mitigation, and regulatory requirements.
• Maintain contract documentation and reporting processes in accordance with organizational policies and regulatory standards.

Provider Enrollment, Licensing, and Auditing

• Oversee provider enrollment and payer credentialing activities to ensure timely participation and reimbursement.
• Audit provider applications, enrollment submissions, licensing documents, certifications, and supporting records for completeness and accuracy.
• Ensure maintenance of all necessary licenses, certifications, registrations, and documentation required by contracting entities and regulatory agencies.
• Coordinate corrective actions and follow-up activities related to documentation deficiencies or compliance concerns.
• Monitor enrollment and credentialing status to minimize reimbursement disruptions and maintain network participation.

Reporting and Analysis

• Develop and present reports regarding contract performance, reimbursement trends, negotiation outcomes, compliance findings, and financial impacts.
• Analyze payer data, contract terms, utilization trends, and reimbursement performance to support strategic decision-making.
• Track key performance indicators related to contract management, payer performance, and contracting initiatives.
• Provide recommendations to leadership regarding payer strategy, contracting opportunities, and market trends.

Qualifications

Essential Qualifications:

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Public Administration, or a related field.
• Minimum of five (3) years of experience in healthcare contracting, managed care contracting, payer relations, provider enrollment, or a related area.
• Demonstrated experience negotiating managed care and commercial payer contracts.
• Strong knowledge of healthcare reimbursement methodologies, fee schedules, and value-based payment models.
• Experience reviewing and interpreting complex contractual agreements and regulatory requirements.
• Knowledge of provider credentialing, enrollment, licensing, and compliance processes.
• Strong analytical, financial, negotiation, and problem-solving skills.

Preferred Qualifications:

• Master's degree in Healthcare Administration, Business Administration, Public Health, Finance, or a related field.
• Certification in healthcare contracting, managed care, compliance, or healthcare financial management.
• Experience with value-based care arrangements, risk-sharing models, and alternative payment methodologies.
• Knowledge of Medicare, Medicaid, and commercial payer regulations.
• Experience working in behavioral health, healthcare systems, provider organizations, or managed care environments.

What We Offer: Competitive Pay - Excellent Benefits - On The Job Training - Upward mobility - Educational assistance to help you grow with us in this life saving field!

Gaudenzia is proud to be an employer of choice - and a treatment provider of choice - in the substance use and co-occurring disorders treatment field. We work hard to foster an inclusive, supportive environment where our employees and clients always feel safe and welcome.

Come work with us!

Our Agency is committed to the principles of equal employment. We believe in fostering a positive work environment in which every employee is treated with respect. Our staff hiring and recruitment practices are grounded in fairness, transparency, and merit. All employment decisions are based on job-related qualifications, relevant skills, experience, and alignment with our mission and values. We actively recruit from a broad range of educational and professional backgrounds to attract the most qualified candidates, ensuring equal opportunity for all applicants without preference or discrimination. Our process uses consistent and clear evaluation criteria to support objective decision-making. By emphasizing accountability, efficiency, and integrity throughout every stage--from job posting to onboarding--we build a workforce defined by excellence, professionalism, and commitment to our shared purpose. Gaudenzia is dedicated to the fulfillment of this policy regarding all aspects of employment, including but not limited to recruiting, hiring, placement, transfer, training, promotion, rates of pay, and other compensation, termination, and all other terms, conditions, and privileges of employment.