Managed Care Contracting Lead

Engagement Type: Independent Contractor (1099)
Schedule: Flexible; approximately 10–20 hours per week initially
Location: Remote
Growth Opportunity: Potential transition to a part-time or full-time position

Position Summary

BrentCare Behavioral Health is seeking an experienced Managed Care Contracting Lead to manage the full end-to-end payor contracting process across multiple entities, markets, and behavioral health service lines.

This individual must have direct experience leading commercial payor contract negotiations, developing contracting strategy, analyzing reimbursement proposals, negotiating financial and contractual terms, coordinating implementation, and validating post-effective-date performance.

Experience in behavioral health is strongly preferred. Prior experience helping providers transition from out-of-network to in-network participation is particularly valuable, including evaluating the financial and operational impact of lower contracted rates, increased volume, utilization requirements, authorization processes, and changes to revenue-cycle workflows.

The role will initially be structured as an independent contractor engagement focused on defined managed care projects and contracting priorities. As BrentCare continues to grow, the position may develop into a regular part-time or full-time role.

Key Responsibilities

Payor Contracting and Negotiations

• Lead the full lifecycle of commercial payor contracting, from initial outreach and proposal development through negotiation, execution, implementation, and ongoing contract management.
• Serve as a primary point of contact with health plans, network representatives, contracting teams, and other external stakeholders.
• Develop and execute payor-specific contracting strategies based on market conditions, reimbursement performance, service-line priorities, and organizational growth plans.
• Lead negotiations involving reimbursement rates, fee schedules, contractual language, administrative requirements, term provisions, termination rights, and operational obligations.
• Prepare rate proposals, counterproposals, financial analyses, market comparisons, and supporting materials for contract negotiations.
• Evaluate proposed contract terms and communicate financial, operational, clinical, and revenue-cycle implications to leadership.
• Coordinate contract review with finance, legal, revenue cycle, operations, credentialing, and clinical leadership.
• Maintain negotiation momentum through disciplined follow-up, issue tracking, and escalation of unresolved items.
• Support contract renewals, amendments, rate increases, new service-line additions, and geographic or entity expansions.

Out-of-Network to In-Network Strategy

• Evaluate opportunities to transition facilities, programs, or service lines from out-of-network to in-network participation.
• Model the impact of proposed in-network rates, expected volume changes, authorization requirements, utilization controls, denial trends, and collection timing.
• Compare historical out-of-network collections with proposed contracted reimbursement to assess financial viability.
• Identify operational changes required to support in-network participation, including admissions processes, verification of benefits, authorizations, concurrent review, claims submission, and denial management.
• Develop implementation plans for OON-to-INN transitions and coordinate readiness across operations, clinical, utilization review, finance, and revenue cycle.
• Monitor census, reimbursement, denials, collections, and payor mix following the transition to validate expected results.
• Identify issues that may limit the value of an in-network agreement and recommend corrective actions or renegotiation strategies.

Contracting Implementation

• Manage contracting activities from initial opportunity assessment through the effective date and operational launch.
• Coordinate payor applications, letters of interest, credentialing submissions, facility enrollment, provider enrollment, and supporting documentation.
• Confirm that contracts, amendments, fee schedules, and negotiated terms are accurately reflected in final documents.
• Develop implementation plans for newly executed contracts, including effective dates, billing requirements, authorization procedures, claims submission requirements, and operational dependencies.
• Partner with revenue cycle and operations teams to ensure contracted rates and payor requirements are properly loaded and operationalized.
• Monitor initial claims and payments following contract implementation to validate reimbursement accuracy.
• Resolve discrepancies between negotiated terms, contract language, system configuration, and actual claims payments.
• Maintain complete records of contracts, amendments, fee schedules, correspondence, approvals, and implementation documentation.

Financial and Managed Care Analysis

• Analyze reimbursement rates by payor, entity, facility, market, service line, billing code, and level of care.
• Compare proposed and existing contracted rates against out-of-network collections, historical reimbursement, market benchmarks, and organizational targets.
• Build financial models to evaluate the impact of proposed rates, volume assumptions, utilization requirements, and transitions from out-of-network to in-network participation.
• Identify underpayments, contract variances, denials, reimbursement discrepancies, and potential contract-compliance issues.
• Develop reports and dashboards showing negotiation status, contracting progress, reimbursement performance, effective dates, and priority action items.
• Identify opportunities to extend existing payor relationships to additional entities, facilities, states, or service lines.
• Support leadership in prioritizing contracting opportunities based on financial impact, strategic importance, and ease of implementation.

Qualifications

• Bachelor’s degree in finance, accounting, business, healthcare administration, economics, or a related field.
• At least five years of experience in managed care contracting, payor negotiations, healthcare reimbursement, network development, or a closely related function.
• Demonstrated experience personally leading commercial payor contract negotiations.
• Proven experience managing the full end-to-end contracting process, including:
• • Payor outreach and relationship development
  • Contracting strategy
  • Rate analysis and proposal development
  • Contract and reimbursement negotiations
  • Contract review and execution
  • Credentialing and enrollment coordination
  • Implementation and effective-date management
  • Post-implementation reimbursement validation
• Strong knowledge of commercial health plan contracting and healthcare reimbursement methodologies.
• Ability to independently review and interpret managed care agreements, fee schedules, amendments, and reimbursement provisions.
• Strong financial and analytical skills, including the ability to model the impact of proposed contract terms.
• Advanced proficiency in Microsoft Excel or Google Sheets.
• Strong project-management skills with the ability to manage multiple negotiations, applications, and implementation workstreams simultaneously.
• Excellent written, verbal, and negotiation skills.
• Ability to communicate effectively with health plan representatives, executives, attorneys, clinicians, operations leaders, and revenue-cycle personnel.
• High level of discretion when handling confidential financial, contractual, patient, and organizational information.

Preferred Experience

• Direct experience in behavioral health managed care contracting.
• Familiarity with residential treatment, partial hospitalization, intensive outpatient, outpatient, and virtual behavioral health services.
• Experience leading transitions from out-of-network to in-network participation.
• Experience evaluating the financial tradeoffs between OON collections and INN reimbursement.
• Familiarity with behavioral health procedure codes, revenue codes, authorization requirements, concurrent review, and reimbursement structures.
• Experience negotiating both facility and professional reimbursement arrangements.
• Experience with Blue Cross Blue Shield plans, national commercial payors, employer-sponsored plans, and behavioral health carve-out organizations.
• Experience supporting multi-state and multi-entity healthcare organizations.
• Familiarity with credentialing, facility enrollment, provider enrollment, claims configuration, and contract-loading processes.
• Experience identifying and resolving reimbursement discrepancies after contract implementation.

Initial Contractor Priorities

Initial projects may include:

• Leading active and upcoming commercial payor contract negotiations.
• Evaluating OON-to-INN opportunities by payor, market, facility, and service line.
• Developing financial models to assess proposed in-network rates and expected volume changes.
• Reviewing existing payor relationships and identifying opportunities for rate increases, amendments, or expansion.
• Creating a comprehensive inventory of contracts, reimbursement schedules, renewal dates, and negotiation priorities.
• Managing contracting and credentialing workflows for new facilities, entities, markets, and service lines.
• Coordinating implementation of newly executed agreements.
• Validating initial claims payments against negotiated reimbursement terms.
• Identifying underpayments and contract-compliance issues.
• Establishing a repeatable end-to-end managed care contracting process for the organization.

Independent Contractor Structure

This position will begin as an independent contractor engagement. The contractor will be expected to independently manage assigned negotiations and deliverables, subject to agreed-upon objectives, deadlines, confidentiality obligations, and organizational requirements.

The initial workload is expected to average approximately 10–20 hours per week but may fluctuate based on negotiation activity and project demands. Compensation may be structured on an hourly, monthly, or project basis.

Based on performance, organizational growth, workload, and mutual interest, the engagement may develop into a regular part-time or full-time employment opportunity. Any future employment arrangement would be separately evaluated and documented.

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