Cleveland Clinic is a not-for-profit academic medical center and multispecialty health system headquartered in Cleveland, Ohio. Since its founding in 1921, the organization has combined patient care with medical research and education across a large healthcare workforce and facilities in Northeast Ohio and other locations worldwide. Its clinical services span specialties including cancer care, women’s health, dermatology, and cardiovascular medicine. The health system’s accreditation by The Joint Commission reflects its adherence to established standards for healthcare quality and safety.
Senior Managed Care Contract Manager at Cleveland Clinic (Hybrid)
Lead managed care contract negotiations for Cleveland Clinic Health System. Evaluate financial, legal, and operational terms across healthcare payer agreements.
Description
- Negotiate contracts for CCF within an assigned business area
- Assess potential new business opportunities
- Oversee administrative, legal, operational, and financial matters tied to contract negotiations
- Contribute to contracting strategy, business planning, and implementation
- Plan, coordinate, and manage contract negotiations
- Identify opportunities and assess financial terms for assigned contracts
- Evaluate legal risks in contract provisions
- Draft suitable legal and financial contract language
- Coordinate and contribute to legal reviews
- Prepare responses, letters of agreement, and essential contract provisions
- Develop and execute business growth strategies
- Identify and focus on targeted development areas
- Build and initiate professional relationships
- Monitor contract history and progress
- Act as the primary contact for third-party payers and internal clients during agreement development, negotiation, and review
- Evaluate both parties’ contractual performance for compliance and resolve conflicts or changes at renewal
- Create methodologies and review models to assess proposals’ financial impact
- Revise methodologies as contract matters evolve
- Prepare responses to Requests for Proposals (RFPs) when required
Requirements
- Bachelor’s degree in healthcare, finance, marketing, or a related field plus five years of contract management experience, or a high school diploma/GED or equivalent plus nine years of related experience
- Substantial managed care contracting experience with health systems, including hospital, professional, and ancillary services
- Experience negotiating Fee for Service and Value Based arrangements for Commercial, Medicaid, Medicare Advantage, and Marketplace plans
- Understanding of revenue cycle and managed care business operations
- Experience in managed care
- Experience spanning service lines such as heart and vascular, transplant, and women’s health
- Managed care contracting experience within a health system
- Experience with claims payment methodologies and related operations
- Practical experience negotiating and managing health insurance contracts
- Working knowledge of current healthcare policies, practices, operations, and reimbursement methodologies
- Knowledge of physician practice management, hospital administration, and operations
- Skills in rate and contract negotiation and stakeholder influence
- Ability to communicate and exchange accurate information
- Ability to work in a stationary position for extended periods
- Ability to handle physical records or operate a computer and other office equipment
- Ability to comply with drug testing and Cleveland Clinic’s influenza prevention program
- Candidates must live in Ohio, Florida, or Nevada
Benefits
- Remote work schedule from 8:00 a.m. to 5:00 p.m.
- Annual half-day on-site team meeting in Cleveland
- Equal employment opportunity
- Drug-free workplace
- Influenza prevention program requiring annual vaccination or an approved exemption
- Personal protective equipment when required
- Support and recognition from Cleveland Clinic
- Rewarding career with Cleveland Clinic Health System