Managed Care Contracting, Performance Advisor

Guidehouse

. Strategically manage, evaluate, negotiate, implement, and monitor managed care contracts .

Posted 10/26/2026full-timeRemote • United StatesMid-LevelSenior💰 $113,000 - $188,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing and negotiating managed care contracts, with a strong focus on financial modeling, reimbursement analysis, and strategic decision-making. Proficient in developing negotiation plans and maintaining relationships with payers to optimize reimbursement outcomes.

Highest-signal resume keywords

Managed Care Contract NegotiationFinancial ModelingReimbursement AnalysisHealthcare FinanceProject Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Reimbursement MethodologiesContract ReviewData AnalysisKPI MonitoringValue-Based Payment ModelsContract Language InterpretationPayer RelationsNegotiation StrategiesHealthcare AnalyticsFinancial Impact Analysis

Soft Skills

Communication SkillsRelationship ManagementOrganizational SkillsCollaborationProblem-Solving

Tools & Technologies

Microsoft ExcelMicrosoft PowerPointHealthcare Financial Analytics Tools

Industry Keywords

Managed CareHealthcare ProviderRevenue CycleMedicareMedicaidContracting StrategiesPayer CommunicationsFinancial SustainabilityMarket ExpansionAlternative Payment Models

About the role

Key responsibilities & impact

Strategically manage, evaluate, negotiate, implement, and monitor managed care contracts
Review and audit existing contracts to identify reimbursement improvement, optimization, and renegotiation opportunities
Perform financial modeling and reimbursement analyses for rate changes, amendments, and new payer arrangements
Evaluate contract language, reimbursement methodologies, payment policies, authorization requirements, carve-outs, and contractual obligations
Develop business cases and executive-level recommendations for contract strategy decisions
Develop and execute negotiation plans for commercial, Medicare Advantage, Managed Medicaid, and other payers
Analyze payer proposals and prepare data-supported counterproposals
Maintain payer communications and relationships to resolve negotiation issues and facilitate contract execution
Coordinate implementation of new or amended managed care agreements
Collaborate with Finance, Revenue Cycle, Patient Access, Case Management, Physician Services, Operations, and payer organizations
Develop contract summaries, reimbursement guides, and operational reference materials
Support payer configuration, billing implementation, reimbursement validation, and operational education
Resolve contract interpretation and post-implementation issues
Establish and monitor KPIs for reimbursement accuracy, denial trends, payment timeliness, underpayments, and revenue yield
Investigate, escalate, and help resolve underpayment, denial, and reimbursement disputes
Analyze payer performance and identify revenue recovery and compliance improvements
Prepare executive reports and presentations on contract performance, negotiation progress, financial impact, and recommendations
Identify and evaluate new payer, IPA, medical group, and physician contracting opportunities
Support physician network and medical group contracting strategies
Assist with value-based care, risk-based contracting, and alternative payment model initiatives
Contribute to managed care strategies supporting organizational growth, financial sustainability, and market expansion

Requirements

What you’ll need

Bachelor's degree and a minimum 6-8+ years of prior relevant experience, or an AA degree and 8-10+ years of prior relevant experience
Relevant experience may be substituted for formal education or advanced degree
Relevant experience in a healthcare provider, central business office environment, managed care, contracting, healthcare finance, payer relations, related healthcare administrative roles, or revenue cycle outsourcing company
Demonstrated experience negotiating managed care agreements with commercial and government-sponsored health plans
Experience performing reimbursement analyses, financial modeling, and contract reviews
Knowledge of hospital and physician reimbursement methodologies, including Medicare, Medicaid/Medi-Cal, DRG, APC, fee schedules, capitation, and value-based payment models
Strong understanding of managed care contract language and reimbursement structures
Advanced analytical and financial modeling skills
Ability to interpret complex contractual and reimbursement provisions
Negotiation, communication, and relationship-management skills
Ability to work effectively across multiple departments and levels of the organization
Strong project management and organizational skills
Proficiency in Microsoft Excel, PowerPoint, and healthcare financial analytics tools
Up to 10% travel
No clearance required

Benefits

Comp & perks

Competitive compensation
Flexible benefits package
Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program