Job Description
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Day - 08 Hour (United States of America)
This is a Stanford Health Care job.
A Brief Overview
The Sr Consultant Managed Care serves as a key contributor supporting the organization's managed care strategy and contracting activities. This role partners with leadership and cross-functional teams to advance payor contracting efforts, manage policy review processes, and support agreement development. The position bridges strategic priorities and operational execution, enabling efficient and consistent management of managed care initiatives.
Locations
Stanford Health Care
What you will do
Support development, review, and negotiation of managed care agreements across all agreement types, including but not limited to hospital, professional and transplant agreements
Assist with drafting, reviewing, and maintenance of network participation agreements, amendments, renewals, and Letters of Agreement (LOAs) as directed by leadership
Serve as the primary Managed Care representative for payor policy review and governance coordination. Lead cross-functional evaluation of policy updates and bulletins, synthesize financial, operational, and clinical impacts, and partner with Legal, Revenue Cycle and Managed Care Leadership to assist in the development and execution of formal responses. Maintains a thorough operational knowledge of contractual agreements and specific contractual language
Negotiate varied and complex reimbursement methodologies
Provide Revenue Cycle with contract details and reimbursements to implement terms
Collaborates closely with applicable service line administration and Revenue Cycle to ensure compliance with the terms of assigned agreements
Serve as a central resource for contract-related questions, ensuring consistency in language, approach, and documentation
Support preparation for complex payor negotiations, including data gathering, analysis, and document preparation
Monitor, review, and summarize state and federal regulatory updates impacting health care reimbursement and contracting, and communicate key implications and recommended actions to internal stakeholders
Participate in managed care strategy discussions and contribute insights to inform contracting and payor engagement approaches
Identify and implement process improvements to reduce administrative burden and enhance operational efficiency
Gradually assume ownership of select contract components, payor relationships, or negotiation elements, as appropriate.
Other duties as assigned
Education Qualifications
Bachelor's degree in a related field from an accredited college or university required.
Experience Qualifications
5 years of experience in managed care, healthcare contracting, or payor relations required.
Experience with payor policies, reimbursement methodologies, and regulatory requirements impacting health care contracting across multiple jurisdictions required.
Required Knowledge, Skills and Abilities
Ability to influence, negotiate, and collaborate effectively with internal and external stakeholders
Strong analytical skills, including financial analysis and experience working with complex data sets
Ability to interpret and draft complex contract language with a high degree of accuracy and attention to detail
Knowledge of managed care reimbursement methodologies, medical billing, and coding practices
Ability to manage multiple priorities and deadlines in a fast-paced, evolving environment
Ability to assess internal and external requirements and reprioritize effectively
Strong problem-solving skills with the ability to mediate and resolve complex issues
Excellent written and verbal communication skills, including the ability to present complex information clearly
High level of organization, attention to detail, and accountability
Proficiency in Microsoft Office applications, including Excel, Word, and PowerPoint
Knowledge of systems and tools used to support managed care contracting and analysis
Ability to exercise sound judgment and maintain confidentiality in handling sensitive information
Licenses and Certifications
None required
These principles apply to ALL employees:
SHC Commitment to Providing an Exceptional Patient & Family Experience
Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.
You will do this by executing against our three experience pillars, from the patient and family’s perspective:
Know Me: Anticipate my needs and status to deliver effective care
Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
Coordinate for Me: Own the complexity of my care through coordination
Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
Base Pay Scale: Generally starting at $59.21 - $78.43 per hourThe salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.