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Exemption Status:

Hiring Range:

Please note that the final offer may vary within this range based on a candidates experience skills qualifications and internal equity considerations.

Schedule Details:

Scheduled Hours:

Shift:

Hours:

Cost Center:

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health everyone is a caregiver regardless of their title or responsibilities. Exceptional patient care academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts and a place where we can help you build the career you deserve. We are more than 20000 employees working together as one health system in a relentless pursuit of healing for our patients community and each other. And everyone in their own unique way plays an important part every day.

I. Major Responsibilities:

• Leads enterprisewide highdollar payer negotiations with limited executive oversight

• Serves as final preparer and internal presenter of negotiation strategy and recommendations to leadership

• Directs advanced financial modeling and scenario analysis

• Assesses and advises leadership on longterm financial operational and regulatory risk

• Authorized to negotiate and recommend contract terms within defined financial thresholds

• Exercises independent judgment in resolving complex payer disputes with material financial impact

• Responds to all inquiries relating to high volume managed care contracts from medical center personnel physicians and/or physicians office staff. Interprets contract language and ensures that the terms of contracts are communicated and implemented accurately within the system. Resolves issues relating to health plan credentialing claims payment referral management and various administrative issues.

• Develops and standardizes contracting templates negotiation guidelines and best practices

• Plays a lead role in shaping payer strategy contracting policy and market positioning

• Coordinates site visits required for credentialing for new and existing programs.

• Acts as primary liaison with high volume managed care plans in addressing operational issues arising under the managed care contracts. Meets regularly with representatives from the high-volume managed care plans to ensure contractual obligations are met and to resolve issues raised by UMass Memorial Medical Center and UMass Memorial Medical Group personnel.

• Manages high volume contracts to ensure compliance and collaborates with the Director Legal Finance and other departments as appropriate is responsible for renewing and renegotiating contract terms. Drives financial analysis and negotiation of value-based contracts. Collaborates on contracting for ancillary services including home health & hospice and MRI services and affiliate hospital risk contracts.

• Drives resolution of technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved.

• Serves as a technical subjectmatter expert and mentor for Contract Managers

• May act in a lead role on crossfunctional initiatives involving Legal Finance Compliance and Operations

• Primary liaison for internal departments and member hospital staff requiring out of network single case agreement negotiations.

• Responsible for negotiating applicable single-case agreements.

• Collaborates with leadership on departmental priorities and goals in relation to contract renewal

II. Position Qualifications:

License/Certification/Education:

Required:

• BS degree or equivalent in Business Health Care Administration or Managed Care Administration.

Preferred:

• Masters (MBA MHA MPH or JD strongly preferred

Experience/Skills:

Required:

• 7 years experience in hospital physician office clinical or managed care setting; thorough understanding of clinical operations health care terminology and current market conditions.

• 5 years direct managed care-contracting experience with direct experience analyzing and negotiating complex contracts and must have a thorough understanding of intricate managed care financial arrangements and boilerplate negotiations.

• Advanced expertise with value-based contracting required.

• Strong knowledge of commercial Medicare Advantage and Managed Medicaid markets preferred.

• Excellent verbal and written communication skills.

• Proficiency with Microsoft Office applications.

• Solid negotiation skills necessary for contract negotiations.

Unless certification licensure or registration is required an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability or protected veteran status.

Were striving to make respect a part of everything we do at UMass Memorial Health for our patients our community and each other. Our six Standards of Respect are: Acknowledge Listen Communicate Be Responsive Be a Team Player and Be Kind. If you share these Standards of Respect we hope you will join our team and help us make respect our standard for everyone every day.

As an equal opportunity and affirmative action employer UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race color religion gender sexual orientation national origin age disability gender identity and expression protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability please contact us at We will make every effort to respond to your request for disability assistance as soon as possible.