Senior Consultant, Managed Care

Role Description

The Sr Consultant Managed Care serves as a key contributor supporting the organization's managed care strategy and contracting activities. This role partners with leadership and cross-functional teams to advance payor contracting efforts, manage policy review processes, and support agreement development. The position bridges strategic priorities and operational execution, enabling efficient and consistent management of managed care initiatives.

• Support development, review, and negotiation of managed care agreements across all agreement types, including but not limited to hospital, professional and transplant agreements.
• Assist with drafting, reviewing, and maintenance of network participation agreements, amendments, renewals, and Letters of Agreement (LOAs) as directed by leadership.
• Serve as the primary Managed Care representative for payor policy review and governance coordination.
• Lead cross-functional evaluation of policy updates and bulletins, synthesize financial, operational, and clinical impacts, and partner with Legal, Revenue Cycle, and Managed Care Leadership to assist in the development and execution of formal responses.
• Maintain a thorough operational knowledge of contractual agreements and specific contractual language.
• Negotiate varied and complex reimbursement methodologies.
• Provide Revenue Cycle with contract details and reimbursements to implement terms.
• Collaborate closely with applicable service line administration and Revenue Cycle to ensure compliance with the terms of assigned agreements.
• Serve as a central resource for contract-related questions, ensuring consistency in language, approach, and documentation.
• Support preparation for complex payor negotiations, including data gathering, analysis, and document preparation.
• Monitor, review, and summarize state and federal regulatory updates impacting health care reimbursement and contracting, and communicate key implications and recommended actions to internal stakeholders.
• Participate in managed care strategy discussions and contribute insights to inform contracting and payor engagement approaches.
• Identify and implement process improvements to reduce administrative burden and enhance operational efficiency.
• Gradually assume ownership of select contract components, payor relationships, or negotiation elements, as appropriate.
• Other duties as assigned.

Qualifications

• Bachelor's degree in a related field from an accredited college or university required.
• 5 years of experience in managed care, healthcare contracting, or payor relations required.
• Experience with payor policies, reimbursement methodologies, and regulatory requirements impacting health care contracting across multiple jurisdictions required.

Requirements

• Ability to influence, negotiate, and collaborate effectively with internal and external stakeholders.
• Strong analytical skills, including financial analysis and experience working with complex data sets.
• Ability to interpret and draft complex contract language with a high degree of accuracy and attention to detail.
• Knowledge of managed care reimbursement methodologies, medical billing, and coding practices.
• Ability to manage multiple priorities and deadlines in a fast-paced, evolving environment.
• Ability to assess internal and external requirements and reprioritize effectively.
• Strong problem-solving skills with the ability to mediate and resolve complex issues.
• Excellent written and verbal communication skills, including the ability to present complex information clearly.
• High level of organization, attention to detail, and accountability.
• Proficiency in Microsoft Office applications, including Excel, Word, and PowerPoint.
• Knowledge of systems and tools used to support managed care contracting and analysis.
• Ability to exercise sound judgment and maintain confidentiality in handling sensitive information.

Benefits

• SHC Commitment to Providing an Exceptional Patient & Family Experience.
• Equal Opportunity Employer: Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment.
• Base Pay Scale: Generally starting at $59.21 - $78.43 per hour.