Senior Value Based Care Contract Specialist
Inside Higher Ed, Columbus, OH, United States
Scope Of Position
The Managed Care Department is responsible for developing and implementing the managed care strategies and objectives for the OSU Health System University Hospitals, The James, University Reference Labs and related entities (OSUHS). The department negotiates and manages agreements with managed care organizations and pursues initiatives related to improvement of OSUHSs ability to compete in a managed care environment.
Position Summary
We are seeking an experienced Senior Managed Care Contracting Specialist with deep expertise in value‑based care (VBC) contracting and regulatory oversight across CMS and Ohio Medicaid programs. This role requires advanced analytical capability, strong payer‑provider contract interpretation skills, and hands‑on experience operationalizing VBC financial models. A special emphasis is placed on expertise with the Ohio Medicaid Comprehensive Integrated Care Incentive Program (CICIP), including regulatory requirements, methodology, reporting standards, and compliance obligations.
The Senior Specialist will support contract development, negotiation, modeling, performance monitoring, and regulatory readiness for all value‑based payer agreements. This role partners closely with Managed Care, Population Health, Compliance, Finance, Legal, and Clinical Operations to ensure organizational success in current and emerging risk‑based payment structures.
Responsibilities
• In the area of Value‑Based Contract Development and Negotiation, this role leads the strategy, development, and negotiation of complex VBC arrangements across Medicare Advantage, Medicaid Managed Care, and Commercial payers.
• The Senior Contract Specialist is responsible for shaping contract structures, aligning incentives, defining performance expectations, and ensuring financial and operational feasibility.
• Strong understanding of analytical methodologies and financial modeling, enabling informed decision‑making and the ability to evaluate upside/downside risk, shared savings potential, quality incentive pathways, and performance‑based revenue opportunities.
• Serve as the primary resource for value‑based payment structures, compliance expectations, and emerging payer strategies, interpreting and operationalizing Ohio Medicaid managed care regulations, with specific expertise in the CICIP program.
• Lead organizational readiness, compliance alignment, and internal education on CICIP program design, performance metrics, incentive methodologies, data submission requirements, and provider performance expectations.
• Partner with analytic stakeholders to ensure contract terms are accurately modeled, tracked, and evaluated throughout the performance cycle, developing dashboards and reporting that quantify contract performance, incentive opportunities, and financial exposure.
• Collaborate across clinical, operational, financial, and population health leaders to ensure value‑based arrangements are operationally feasible and strategically aligned with organizational capabilities.
• Work with legal teams to refine contract language, clarify regulatory obligations, and ensure compliant data‑sharing and reporting structures.
• Ensure all negotiated agreements adhere to managed care and regulatory standards, including documentation and audit readiness.
Qualifications
Bachelor's Degree in Business Administration, Healthcare Administration, Finance, Public Health, Marketing or related field.
4 years of relevant experience required; 4‑8 years preferred. Master’s preferred.
3+ years of experience in managed care contracting, payer/provider analytics, or value‑based care program management.
Demonstrated experience with CMS VBC models and Ohio Medicaid managed care programs.
In‑depth knowledge of Ohio Medicaid’s CICIP structure, metrics, financial methodologies, and reporting.
Excellent contract interpretation skills and the ability to translate technical terms into actionable insights.
Strong communication skills with the ability to influence stakeholders at all levels.
Ability to work under stress and deadlines, cope with frequent interruptions and prioritize.
Knowledge of healthcare terminology and reimbursement methods.
Familiarity with quality assurance and utilization review standards. Proficiency with MS Office suite.
Benefits
An array of retirement plan options, each with a generous employer contribution.
Affordable health insurance options, including dental, vision and prescription coverage that begin on day one.
Paid vacation and sick leave, including short and long‑term disability and paid parental leave.
Access to the Public Service Loan Forgiveness program.
And much more.
Additional Information
Location: Ackerman Rd, 660 (0242)
Position Type: Regular
Scheduled Hours: 40
Shift: First Shift
Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.
The university is an equal opportunity employer, including veterans and disability.
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The Managed Care Department is responsible for developing and implementing the managed care strategies and objectives for the OSU Health System University Hospitals, The James, University Reference Labs and related entities (OSUHS). The department negotiates and manages agreements with managed care organizations and pursues initiatives related to improvement of OSUHSs ability to compete in a managed care environment.
Position Summary
We are seeking an experienced Senior Managed Care Contracting Specialist with deep expertise in value‑based care (VBC) contracting and regulatory oversight across CMS and Ohio Medicaid programs. This role requires advanced analytical capability, strong payer‑provider contract interpretation skills, and hands‑on experience operationalizing VBC financial models. A special emphasis is placed on expertise with the Ohio Medicaid Comprehensive Integrated Care Incentive Program (CICIP), including regulatory requirements, methodology, reporting standards, and compliance obligations.
The Senior Specialist will support contract development, negotiation, modeling, performance monitoring, and regulatory readiness for all value‑based payer agreements. This role partners closely with Managed Care, Population Health, Compliance, Finance, Legal, and Clinical Operations to ensure organizational success in current and emerging risk‑based payment structures.
Responsibilities
• In the area of Value‑Based Contract Development and Negotiation, this role leads the strategy, development, and negotiation of complex VBC arrangements across Medicare Advantage, Medicaid Managed Care, and Commercial payers.
• The Senior Contract Specialist is responsible for shaping contract structures, aligning incentives, defining performance expectations, and ensuring financial and operational feasibility.
• Strong understanding of analytical methodologies and financial modeling, enabling informed decision‑making and the ability to evaluate upside/downside risk, shared savings potential, quality incentive pathways, and performance‑based revenue opportunities.
• Serve as the primary resource for value‑based payment structures, compliance expectations, and emerging payer strategies, interpreting and operationalizing Ohio Medicaid managed care regulations, with specific expertise in the CICIP program.
• Lead organizational readiness, compliance alignment, and internal education on CICIP program design, performance metrics, incentive methodologies, data submission requirements, and provider performance expectations.
• Partner with analytic stakeholders to ensure contract terms are accurately modeled, tracked, and evaluated throughout the performance cycle, developing dashboards and reporting that quantify contract performance, incentive opportunities, and financial exposure.
• Collaborate across clinical, operational, financial, and population health leaders to ensure value‑based arrangements are operationally feasible and strategically aligned with organizational capabilities.
• Work with legal teams to refine contract language, clarify regulatory obligations, and ensure compliant data‑sharing and reporting structures.
• Ensure all negotiated agreements adhere to managed care and regulatory standards, including documentation and audit readiness.
Qualifications
Bachelor's Degree in Business Administration, Healthcare Administration, Finance, Public Health, Marketing or related field.
4 years of relevant experience required; 4‑8 years preferred. Master’s preferred.
3+ years of experience in managed care contracting, payer/provider analytics, or value‑based care program management.
Demonstrated experience with CMS VBC models and Ohio Medicaid managed care programs.
In‑depth knowledge of Ohio Medicaid’s CICIP structure, metrics, financial methodologies, and reporting.
Excellent contract interpretation skills and the ability to translate technical terms into actionable insights.
Strong communication skills with the ability to influence stakeholders at all levels.
Ability to work under stress and deadlines, cope with frequent interruptions and prioritize.
Knowledge of healthcare terminology and reimbursement methods.
Familiarity with quality assurance and utilization review standards. Proficiency with MS Office suite.
Benefits
An array of retirement plan options, each with a generous employer contribution.
Affordable health insurance options, including dental, vision and prescription coverage that begin on day one.
Paid vacation and sick leave, including short and long‑term disability and paid parental leave.
Access to the Public Service Loan Forgiveness program.
And much more.
Additional Information
Location: Ackerman Rd, 660 (0242)
Position Type: Regular
Scheduled Hours: 40
Shift: First Shift
Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.
The university is an equal opportunity employer, including veterans and disability.
#J-18808-Ljbffr