Contracting Manager, Payor Strategy

Medically Home operates a decentralized care model for patients with serious, complex or high-risk illnesses in partnership with health systems to safely care for their patients at home, across the care continuum, including hospital-level care. Medically Home provides health systems with all that is needed to safely care for patients, including the clinical protocols, reimbursement model, platform technology, and fulfillment of all the clinical services required in the home through partners. Clinicians and patients broadly prefer this model over traditional care; both clinical and financial outcomes are improved as compared to traditional care.

Medically Home is searching for a Contracting Manager, Payor Strategy to join a dynamic team focused on national customer partnerships. The Contracting Manager will bring customers to value based arrangements that maximize the financial and quality outcomes inherent to the Medically Home model. The role requires business development expertise, a sound understanding of health plan and delivery system contracting strategies, as well as command of revenue cycle sub systems and process specific to both providers and payors. Experience with government, fully insured, and self-insured lines of business, as well as experience working with delegated risk, is required to succeed in this public facing role. Fluency in national care models for primary, specialty, and facility care is required.

Location: REMOTE
Reports to: Director, Payor Strategy

Responsibilities:

• Facilitate project plan development in collaboration with customer Managed Care teams focused on strategies to secure priority payor contracts.
• Works closely with the customer contracting team to review and redline contracts as appropriate.
• Guide customers to signed contracts with payor partners for the MH model.
• Responsible for customer implementations around value-based contracting with payors, facilitating the MH customer revenue cycle solutions, and supporting business development as it relates to reimbursement, compliance, and regulatory issues.
• Foster effective payor partnerships with internal and external sources involved in the contract and management process, development of contract language and negotiation strategy.
• Serve as subject matter expert and point of contact for all network contracting both internally and externally, supporting ongoing payor relationships.
• Works closely with the revenue cycle teams to facilitate contract billing discussions and support critical system build decision-making.
• Maintains up to date knowledge on the healthcare market and reimbursement trends.
• Partners with Chief of Payor Strategy, VP of Payor Strategy, Implementation Manager, Customer Success Managers and Virtual Hospital Administrators to successfully scale the model.
• Effectively communicate internally and externally contracting opportunities and challenges
• Additional responsibilities as required to accomplish projects and departmental goals.

Experience and Qualifications:

• 5+ years of contracting experience spanning the delivery system and payors.
• An emphasis on negotiating value-based arrangements is preferred.
• Sound understanding of health plan and delivery system contracting strategies, as well as command of revenue cycle sub systems, and process specific to both providers and payors.
• Experience with government, fully insured, and self-insured lines of business, as well as significant experience working with delegated risk.
• Fluency in national care models for primary, specialty, and facility care
• Broad understanding of Federal and State regulatory frameworks

Consistent with Medically Home’s values of serving our patients, customers, and team members, Medically Home has implemented a vaccine policy consistent with those commitments. Therefore, all MH team members are required to be vaccinated against COVID-19, have their 1st booster against COVID-19 as well as seasonal influenza.

At Medically Home, we are committed to creating a diverse and inclusive environment. If you are excited about this role or about our company’s mission but you aren’t sure if your past experience ticks all the boxes in this job description - apply anyway. You might just be the right candidate for this or other opportunities in our organization.

Medically Home is an equal employment opportunity employer and is committed to maintaining a non-discriminatory work environment. Medically Home does not discriminate against any employee or applicant for employment on the basis of race, color, religion, sex, national origin, age, disability, veteran status, marital status, sexual orientation, gender identity, or any other characteristic protected by applicable federal and/or state law.