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Sr Manager Payer Strategy (Managed Care Dept.)

NCHS-MANAGED CARE CONTRACTING Florida-Miami-NCHS Corporate Headquarters Miami, Florida Requisition ID 23393


Job Summary

Lead the commercial and governmental contract negotiations for NCHS and NCPS.  Develop complex contractual reimbursement analysis and models to increase net revenue, competitive position, and market share. Oversees and manages delegated credentialing function and support and implement value based payment transformation. Lead and develop people to strengthen all components of the Managed Care function.

Job Specific Duties

  • Manages NCHS and NCPS managed care contract negotiation function. Serves as the primary relationship manager with the payers. 
  • Responsible for preparation and analysis of contract proposals and  evaluating financial impact, understanding internal strategy, and competitive market threats. 
  • Leads and supports contract negotiations by creating a standardized financial and volume/product line reporting suite. 
  • Conducts contract audits to identify areas of opportunity and make proactive recommendations. 
  • Obtains and performs regular physician fee schedule audits of managed care contracts to ensure appropriate level of reimbursement is applied. 
  • Prepares contract rate models forecasting future negotiation rates. 
  • Leads, mentors, and coaches direct reports. 
  • Collaborate with internal departments and affiliated NCHS parties in support of the net revenue and strategic objectives of the Health System.
  • Develops and executes complex business plans (including financial models) and project plans to obtain new business growth for the organization. 
  • Researches and maintains knowledge of payer policies and governmental regulations impacting managed care negotiations and payer relations. 
  • Works cross functionally with NCH and NCPS departments to operationalize systems, audit contract loads, and prepare for organizational changes in order to ensure appropriate contract requirements. 
  • Works with leadership to ensure understanding of strategic objectives in order to negotiate managed care agreements. 
  • Oversee delegated credentialing physician function and make improvements necessary to increase efficiencies. 




Minimum Job Requirements

  • Bachelor's Degree in Business Administration, Healthcare Administration, or related field
  • 7-10 years of experience in hospital and physician managed care negotiations and analytics (strategic planning, business development, financial analysis, forecasting, and data modeling)
  • 7-10 years of experience in leading teams
  • Experience using business intelligence system(s).

Knowledge, Skills, and Abilities

  • Master’s in Business Administration, Healthcare Administration, or related field preferred.
  • FinThrive (previously known as nthrive) or similar contract management tool system preferred.
  • Knowledge of ICD9, ICD10, CPT, DRG and other coding/reimbursement schedules.
  • Advanced Excel modeling, formulas, and automation skills.
  • Strong ability to query data and convert to information in order to address, identify issues, and make recommendations.
  • Ability to communicate verbally and in writing.
  • Able to maintain confidentiality of sensitive information.
  • Able to lead and develop people.
  • Able to analyze and audit contracts to identify any opportunities in payment behavior.
  • Excellent negotiation skills and ability to build payer relationships.
  • Experience in bringing together groups with diverse interests and helping groups to build common goals.
  • Strong skills related to physician and hospital credentialing.
  • Strong skills and knowledge of hospital and physician reimbursement methodology and contract testing.
  • Knowledge of current and future managed care reimbursement methodologies and transformational models.
  • Demonstrates competency in financial and statistical reporting, design, preparation of spreadsheets, and other financial reports.
  • Strong problem solving skills; ability to work independently and make rational decisions.
  • Skills in the use of complex mathematical and statistical techniques to assess financial and statistical scenarios.
  • Strong judgment and decision making skills to lead and develop subordinates.
  • Able to communicate verbal and written information in a clear, concise, and easy to understand manner for use by internal and external groups.

Job :


Primary Location :

Florida-Miami-NCHS Corporate Headquarters

Department :


Job Status

:Full Time

Joining a new organization can be daunting or overwhelming. But at Nicklaus, your colleagues make you feel welcomed. They taught me to celebrate our accomplishments and band together during challenging times. This is not easy to find in healthcare these days, so I’m grateful to have found an amazing place to work with people and leadership who have my well-being in mind.

Lova Renee Brunson Manager Accreditation & Regulatory

Collaboration leads to success.

Alone we can do so little; together we can do so much. Working together, we find solutions and methods we would never find alone, and at Nicklaus Children’s, we have fun doing it.

Responsibility drives us.

We all take responsibility here – for the children, their families, our work and each other. We meet our responsibilities head on and motivate each other to succeed.

Empower yourself, help others.

Nicklaus Children’s encourages team members to believe in their ability to affect positive change in the world through everything they do with us.

Advocate for the right way.

Advocate for children. Advocate for families. Advocate for yourself. But most of all, advocate for getting the job done right and you will find nothing but success and support in your career here.

Transformation is growth.

At Nicklaus Children’s, change is not to be feared. When you work here, you are always working with the most advanced tools and procedures available.

Empathy is everything.

We expect our team members to have empathy for the patients and families they treat, and in turn, we have empathy for them. We take care of everyone in the Nicklaus Children’s family with competitive benefits and our supportive culture.

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As champions for children, Nicklaus Children’s is committed to putting the health and safety of our patients, families, medical staff and employees first. With the increasing number of adults and children in our community experiencing illness from the coronavirus and its variants, our course of action is clear. Vaccination offers proven protection against severe COVID-19-related illness. All members of our team are required to be fully vaccinated against COVID-19. Accommodations are being made for those who have a medical reason where they cannot receive the vaccine or have a strongly held religious basis for not obtaining it.

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