Manager of Managed Care Operations - Hybrid / Remote

About this role

Job Details


Description

• Hybrid based at our corporate office in Brentwood, TN, with on-site work required Monday through Wednesday for candidates in Nashville and surrounding areas.
• Remote option available for candidates outside of surrounding areas.

Duties And Responsibilities

• Develops and executes payer negotiation and contracting strategies for assigned ambulatory surgery centers (ASCs) and physician groups based on market opportunities, reimbursement goals, and organizational value proposition.
• Leads and manages payer contract negotiations, renewals, amendments, and ongoing agreement administration for commercial, managed Medicare, managed Medicaid, workers’ compensation, exchange, and other payer products.
• Partners with facility, operational, and physician leadership to implement payer strategies, address contracting challenges, and align reimbursement initiatives with facility financial and operational objectives.
• Works to achieve facility-specific reimbursement and budget goals through effective negotiation, contract optimization, and targeted market positioning.
• Analyzes payer contracts, reimbursement methodologies, and financial models to support negotiations, identify revenue opportunities, and ensure alignment with projected financial outcomes.
• Collaborates with revenue cycle, business office, and analytics teams to investigate and resolve complex payer issues, including underpayments, overpayments, credentialing concerns, and contract discrepancies.
• Monitors post-implementation contract performance to validate payer compliance, reimbursement accuracy, and consistency with modeled contract expectations.
• Ensures timely and accurate implementation of negotiated contract terms, automatic renewal escalators, contract system updates, and payer reimbursement changes. Maintains strong working relationships with payer representatives, provider relations contacts, and internal stakeholders including executives, CEOs/CFOs, admin...