Job Summary

We are seeking a Senior Manager of Managed Care Contracting to assist in Local Infusion’s growth in the infusion space by driving the managed care process from end-to-end with local, regional, national, and government payers/entities. This is a new role within the organization that will help develop the vision and the execution of payer strategy. The Sr. Manager will report to the Executive Director of Managed Care Partnerships. The primary responsibility of this role is to contribute to the growth of Local Infusion through payer contracting growth, expansion, and re-negotiations. The Manager collaborates across departments and with key stakeholders to ensure effective coordination of Managed Care Contracting activities across the organization and maintains crucial relationships with health plans and payers-relationships.

Key Responsibilities

• Initiate, develop, negotiate, and monitor contracts for Local Infusion, including contract renewals, amendments, and new agreements. Engage directly with finance, field leaders, and other stakeholders to negotiate payment rates, structures, and contract terms.

• Facilitate relationships with health plan partners and effectively communicate value creation by Local Infusion.

• Effectively communicate complex information to both technical and non-technical audiences, while building and maintaining strong relationships with key stakeholders, including health plans, ACOs, hospital systems, and provider networks.

• Oversee claims processing, appeals management, and utilization management to prevent revenue leakage and ensure timely and efficient resolution.

• Facilitate communication with providers and affiliates, ensuring key contract information regarding operational terms, legal requirements, and rates is shared effectively with operational and revenue cycle teams.

• Coordinate the alignment and integration of Managed Care Contracting efforts with newly acquired organizations and new partnerships, ensuring a smooth and efficient transition that aligns with Local Infusion’s strategic objectives.

• Perform other related duties as required, including leading efforts to stay informed on changes to regulatory requirements that may impact managed care contracting and healthcare operations, ensuring timely adjustments to strategies and compliance.

The above listing of duties and responsibilities are not intended to be all-inclusive but rather to serve as a description of the range of duties and general nature of the position. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

Qualifications and Requirements

• Bachelor's degree in a relevant subject area such as Accounting, Business Administration, Finance, Health Care required.

• Minimum of 7 years of experience in managed care contracting or provider network management, with a proven track record of success in an insurance or healthcare setting.

• Proven experience negotiating contracts with Medicare Advantage plans, Medicaid Managed Care, and commercial payers, ensuring favorable reimbursement rates and risk-sharing models.

• Understanding of reimbursement strategies, including risk-sharing models and value-based payment structures, to ensure financial sustainability and align incentives with quality patient care outcomes.

• Knowledge of payer landscape at a national level, with east coast & midwest-preferred. Existing list of payer contacts & relationships is beneficial.

• Ability to convey complex technical information in clear and concise communications to technical and non-technical audiences.

• Ability to identify issues, analyze data, develop, recommend, and implement solutions.

• Possess initiative, decision-making skills and problem-solving abilities.

• Familiarity with evolving healthcare legislation and compliance requirements is a plus.

• Proven ability to work collaboratively with senior management, providers, and staff.