Ovation Healthcare
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Senior Consultant, Managed Care
role at
Ovation Healthcare . The job is located in our corporate headquarters, Brentwood, TN.
Ovation Healthcare has been improving local healthcare for over 40 years. We support independent hospitals and health systems with guidance, technology-enabled shared services, and operations expertise to help rural providers thrive.
Summary The Senior Consultant of Payer Relations, reporting to the VP of Payer Relations, manages client relationships with a select group of client hospitals. Responsibilities include service and support as the primary liaison between hospitals and managed‑care payers; written assessments of proposed managed‑care agreements; contract negotiation and support; payer communication and administrative assistance; delivery of educational programs; coordination of contract models; and maintenance of a customer database. The consultant participates in client engagements with the project team and prepares and presents client deliverables.
Duties and Responsibilities
Oversee the engagement life cycle and produce client‑ready deliverables.
Lead negotiation of provider and payer contracts ensuring alignment with organizational goals and financial targets.
Drive complex contract initiatives, including new provider networks, negotiation cycles, or service expansions.
Review and analyze data for contract administration—evaluate profitability of contract renewals and existing contracts.
Collaborate with the Payer Relations Team to establish work plans, set priorities, organize tasks, and recommend methodologies, tools, and resources to optimize project profitability.
Develop and maintain resource materials and tools for contract clarification (language templates).
Manage client expectations in line with budget and project objectives.
Assist with updates to the Contract Tracker, contract matrices, client agendas, and other status‑communication documents.
Ensure annual escalators from payers are requested, validated, updated in the contract matrix, and shared with hospital staff.
Track contract performance post‑execution and recommend adjustments as needed (e.g., chargemaster increases).
Maintain accurate documentation of negotiations, versions, and final agreements.
Prepare negotiation assistance, financial models, analysis, and strategy options for leadership.
Develop negotiation strategies based on regulatory requirements, guidelines, and market competition.
Conduct detailed claims analysis to assess financial impact of proposed contract terms.
Analyze contract terms and reimbursement methodologies for all negotiations.
Implement best practices and process improvements for contract lifecycle management.
Possess a keen understanding of managed care contracting and related initiatives, including underlying systems.
Identify and analyze user requirements, procedures, and problems to improve reimbursement and explore opportunities.
Perform detailed analysis on multiple projects, recommend potential solutions, and ensure successful implementation.
Monitor market research on reimbursement benchmarks, network adequacy, and industry trends; develop and share organizational best practices.
Build and maintain strong relationships with providers, health systems, payers, and partners.
Prepare high‑level reports summarizing negotiation status, outcomes, financial impact, and strategic recommendations.
Offer strategic guidance to clients and leadership on trends such as value‑based care, telehealth, and alternative payment models.
Manage day‑to‑day client relationships while aligning expectations with budget and objectives.
Assist the Payer Relations Team in quality management of the work product and interact with mid‑level client contacts and above on engagement issues.
Deliver client reports within 30 days of a client meeting.
Knowledge, Skills, and Abilities
Proven track record of achieving goals and objectives related to managed‑care contracting.
Intermediate analytical skills and experience.
Strong communication skills: ability to interact with multiple client levels (hospital/physician/payer plans/corporate staff).
Proficiency in Microsoft applications – Word, Access, Excel.
Critical thinking and problem‑solving abilities.
Work Experience, Education, and Certifications
BS/BA preferred in a related field or relevant experience desired.
Understanding of Medicare/Medicaid government contracting, reimbursement, and regulations.
Healthcare experience required.
3–5 years of Managed Care and/or Payer Relations experience required.
Experience in a managed‑care environment for a healthcare delivery system (facility or professional managed care).
Strong negotiating skills with a successful track record negotiating contracts with individuals, groups, and complex systems.
Travel Requirements
Up to 50% travel.
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Senior Consultant, Managed Care
role at
Ovation Healthcare . The job is located in our corporate headquarters, Brentwood, TN.
Ovation Healthcare has been improving local healthcare for over 40 years. We support independent hospitals and health systems with guidance, technology-enabled shared services, and operations expertise to help rural providers thrive.
Summary The Senior Consultant of Payer Relations, reporting to the VP of Payer Relations, manages client relationships with a select group of client hospitals. Responsibilities include service and support as the primary liaison between hospitals and managed‑care payers; written assessments of proposed managed‑care agreements; contract negotiation and support; payer communication and administrative assistance; delivery of educational programs; coordination of contract models; and maintenance of a customer database. The consultant participates in client engagements with the project team and prepares and presents client deliverables.
Duties and Responsibilities
Oversee the engagement life cycle and produce client‑ready deliverables.
Lead negotiation of provider and payer contracts ensuring alignment with organizational goals and financial targets.
Drive complex contract initiatives, including new provider networks, negotiation cycles, or service expansions.
Review and analyze data for contract administration—evaluate profitability of contract renewals and existing contracts.
Collaborate with the Payer Relations Team to establish work plans, set priorities, organize tasks, and recommend methodologies, tools, and resources to optimize project profitability.
Develop and maintain resource materials and tools for contract clarification (language templates).
Manage client expectations in line with budget and project objectives.
Assist with updates to the Contract Tracker, contract matrices, client agendas, and other status‑communication documents.
Ensure annual escalators from payers are requested, validated, updated in the contract matrix, and shared with hospital staff.
Track contract performance post‑execution and recommend adjustments as needed (e.g., chargemaster increases).
Maintain accurate documentation of negotiations, versions, and final agreements.
Prepare negotiation assistance, financial models, analysis, and strategy options for leadership.
Develop negotiation strategies based on regulatory requirements, guidelines, and market competition.
Conduct detailed claims analysis to assess financial impact of proposed contract terms.
Analyze contract terms and reimbursement methodologies for all negotiations.
Implement best practices and process improvements for contract lifecycle management.
Possess a keen understanding of managed care contracting and related initiatives, including underlying systems.
Identify and analyze user requirements, procedures, and problems to improve reimbursement and explore opportunities.
Perform detailed analysis on multiple projects, recommend potential solutions, and ensure successful implementation.
Monitor market research on reimbursement benchmarks, network adequacy, and industry trends; develop and share organizational best practices.
Build and maintain strong relationships with providers, health systems, payers, and partners.
Prepare high‑level reports summarizing negotiation status, outcomes, financial impact, and strategic recommendations.
Offer strategic guidance to clients and leadership on trends such as value‑based care, telehealth, and alternative payment models.
Manage day‑to‑day client relationships while aligning expectations with budget and objectives.
Assist the Payer Relations Team in quality management of the work product and interact with mid‑level client contacts and above on engagement issues.
Deliver client reports within 30 days of a client meeting.
Knowledge, Skills, and Abilities
Proven track record of achieving goals and objectives related to managed‑care contracting.
Intermediate analytical skills and experience.
Strong communication skills: ability to interact with multiple client levels (hospital/physician/payer plans/corporate staff).
Proficiency in Microsoft applications – Word, Access, Excel.
Critical thinking and problem‑solving abilities.
Work Experience, Education, and Certifications
BS/BA preferred in a related field or relevant experience desired.
Understanding of Medicare/Medicaid government contracting, reimbursement, and regulations.
Healthcare experience required.
3–5 years of Managed Care and/or Payer Relations experience required.
Experience in a managed‑care environment for a healthcare delivery system (facility or professional managed care).
Strong negotiating skills with a successful track record negotiating contracts with individuals, groups, and complex systems.
Travel Requirements
Up to 50% travel.
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