21 Managed Care jobs in Chicago

Job Type

Full-time

Description

Summary

Responsible for all aspects of payer relations. Overall goal of, managing payor relationships and contract negotiations to meet the organization's strategies and financial success. Cultivates relationships to assist with problem resolution while positively advocating and removing barriers to access to ensure coverage and reimbursement.

Essential Duties

• Contract negotiations: Lead contract negotiations with payers to secure favorable reimbursement rates and terms for all segments of IBJI. This includes physicians services in office and surgical setting, imaging, rehabilitation and ASC's. Analyze the potential impact of contract renegotiations by modeling the financial impact.
• Market access strategy development: Contributing to the development and execution of strategies to gain access to payer networks and maximize patient access to services.
• Payer policy analysis: Monitor and analyze payer policies, coverage guidelines and reimbursement methodologies to identify potential challenges and opportunities. Educate leadership, revenue cycle and operations of these challenges and opportunities.
• Quality management: Key knowledge of payor quality measurement tools. Collaborate with internal teams to coordinate strategy and understanding of financial and clinical implications.

• Bachelor's degree is required, advanced degree is preferred.
• Experience in contract negotiations
• Deep knowledge of healthcare, managed care strategy, pricing and medical reimbursement environment required.
• Proven ability of successfully managing complexity, solving problems and building strong relationships.
• Ability to work well independently as well as collaboratively; self motivated and disciplined to meet deadlines in the context of competing priorities and projects; lead and work effectively with cross-functional teams
• Computer literacy, including high level of competency in Excel

5 days ago Be among the first 25 applicants

The Payer Contracting Specialist partners with the SVP of Revenue Cycle on implementing payor strategies, focusing on payor operations, client services, and process improvement. The role primarily involves network development and contracting. It ensures resolution of payor issues from various departments, tracks opportunities, and documents and improves processes continually. This is an entry-level position with available training.

This position is onsite at our Northbrook, Illinois corporate office.

1. Assist in negotiating managed care agreements with payors, health systems, IPA's, and other entities, including language and rate negotiations.
2. Develop a working knowledge of reimbursement strategies and analyze rate proposals.
3. Identify unfavorable contract language in agreements.
4. Assist with implementing payor strategies alongside the Manager of Contracting and Payor Relations.
5. Maintain thorough operational knowledge of contractual agreements and specific language with payors.
6. Coordinate with credentialing regarding demographic updates related to contracting efforts.
7. Collaborate with Operations, legal, billing, and compliance teams to track and resolve payor issues, including payment and billing disputes.
8. Create, document, and improve processes to ensure clear communication throughout contracting efforts.
9. Manage contract assignments and relevant documentation related to negotiation, strategy, and implementation.
10. Monitor and report on current contracting efforts proactively.
11. Partner with internal teams to align contracting efforts with company and divisional goals.
12. Communicate with stakeholders to operationalize contract commitments.
13. Perform additional duties as assigned.

• Bachelor's degree is required; a focus in Health Care Administration, Managed Care Contracting, or a similar field is preferred.
• Prior experience in health care provider or health plan contracting, contract operations, service operations, or provider relations is required.
• Interest in health care operations is required.

• Health
• Dental
• Vision
• 401k
• PTO

• Seniority level: Associate
• Employment type: Full-time
• Job function: Legal
• Industries: IT Services and IT Consulting

Join to apply for the Senior Analyst Managed Care Modeling role at CommonSpirit Health 6 days ago Be among the first 25 applicants Join to apply for the Senior Analyst Managed Care Modeling role at CommonSpirit Health Get AI-powered advice on this job and more exclusive features. *Responsibilities* This is a remote position with preferred Central time zone. Do you enjoy modeling healthcare payer proposals, conducting contract analysis and working on large payer negotiations? We encourage you to apply to this exciting role. The Senior Analyst, Payer Economics performs complex managed care payer financial analysis, strategic pricing and payer contract modeling activities for a defined payer portfolio. Provides analytical and pricing expertise for the evaluation, negotiation, implementation and maintenance of managed care contracts between CommonSpirit Health providers and payers. Recommends strategies for maximizing reimbursement and market share. Provides mentorship and guidance of Analyst contract modeling. Provides analysis findings and education to key stakeholders. This position will serve and support all stakeholders through ongoing educational and problem-solving support for managed care payer reimbursement models. This position requires daily contact with senior management, physicians, hospital staff, and managed care/payer strategy leaders. Lead payer contract modeling strategy and consolidation for large managed care payer negotiations. Act as a liaison between CommonSpirit Health and payer to update information and communicate changes related to reimbursement. Perform complex strategic pricing analysis to support the negotiation and implementation of appropriate reimbursement rates and associated language, between physicians/hospitals and payers/networks for managed care contracting initiatives. Develop and approve financial models and payer performance analysis. Monitor contract financial performance. Analyze and publish managed care performance statements and determine profitability. Review and accurately interpret contract terms, including payer policies and procedures impacting contract performance. Provide training and oversight of the modeling of proposed/existing payer contracts negotiated by payer strategy and operations, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes. Prepare complex service line reimbursement analyses and financial performance analyses. Develop methods and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provision, parameters and rate structures aimed at establishing appropriate reimbursement levels. Identify, collect, and manipulate from a wide variety of financial and clinical internal databases and external sources. Identify and access appropriate data resources to support analyses and recommendations. Prepare and effectively present results to senior leadership, and other key stakeholders, for review and decision-making activities. Maintain knowledge of operations sufficient to identify causative factors, deviations, allowances that may affect reporting findings. Ability to translate operational knowledge to identify unusual circumstances, trends or activity and project the related impact on a timely, pre-emptive basis. *Qualifications* *Required Education and Experience* Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare or related field. Equivalent education and experience in a related field may be considered in lieu of degree. Minimum of three (3) years of experience in financial healthcare reimbursement analysis is required, including an understanding of national standards for fee-for-service provider reimbursement methodologies. *Minimum Required Skills and Abilities* Working knowledge of financial healthcare reimbursement analysis including an understanding of national standards for fee-for-service and value-based provider reimbursement methodologies. Experience in contribution to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations. Basic technical understanding and proficiency in MS Excel, MS Access, PIC, SQL queries, or other related applications. Working knowledge of healthcare financial statements and accounting principles. Ability to use and create data reports from health information systems, databases or national payer websites (EPIC, PIC, SQL Databases, etc.) Proficiency in reading, interpreting and formulating computer and mathematical rules/formulas. *Overview* CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. *Pay Range* 40.80 - $55.00 /hour Seniority level Seniority level Not Applicable Employment type Employment type Full-time Job function Job function Health Care Provider Industries Wellness and Fitness Services, Hospitals and Health Care, and Medical Practices Referrals increase your chances of interviewing at CommonSpirit Health by 2x Get notified about new Senior Healthcare Analyst jobs in Chicago, IL . Chicago, IL $25,000.00- 155,000.00 4 hours ago Payor Relations Manager/Senior Analyst (Healthcare) Greater Chicago Area 70,000.00- 135,000.00 2 weeks ago Downers Grove, IL 73,399.00- 110,098.00 1 week ago Sr Analyst, Population Health, Specialty Partnerships Chicago, IL 46,988.00- 112,200.00 1 week ago Chicago, IL 46,988.00- 112,200.00 1 week ago Chicago, IL 46,988.00- 112,200.00 1 month ago Reviewer-Orthopedic Disease Specific Care Disease Specific -Stroke Reviewer - Intermittent Epic Analyst III - Prelude and Eligibility Downers Grove, IL 85,000.00- 128,000.00 6 months ago Sr Healthcare Risk Adjustment Analyst - Remote Senior Risk Adjustment Coding Quality Assurance Specialist (Remote) Chicago, IL 89,000.00- 148,000.00 2 weeks ago Chicago, IL 68,500.00- 116,300.00 4 months ago VP Sr. Equity Research Analyst - Healthcare HB Coding Analyst, Full-time, Days (Remote - Must reside in IL, IN, IA, or WI) Chicago, IL 67,640.00- 128,160.00 3 hours ago Sr. Pharmacy Analyst, Pricing & Underwriting Chicago, IL 48,000.00- 50,000.00 1 week ago Senior Consultant, UKG and Payroll, Digital Healthcare Senior Consultant, Healthcare Finance & Strategy Senior Consultant, Infor Payroll- Digital Healthcare (Evergreen) (Open) Northbrook, IL 43,888.00- 102,081.00 2 hours ago Senior Consultant, Healthcare Finance & Strategy - Value Based Care Oncology Products Delivery Senior Analyst Chicago, IL 76,725.00- 102,300.00 2 days ago Oncology Products Delivery Senior Analyst Arlington Heights, IL 76,725.00- 102,300.00 2 days ago Payer Compliance Analyst, Full time - Days Burr Ridge, IL 73,300.00- 97,700.00 1 week ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr

Consulting Senior Analyst - Provider Revenue Excellence - Growth & Managed Care Job ID: 98729 Do you want to work on complex and pressing challenges-the kind that bring together curious, ambitious, and determined leaders who strive to become better every day? If this sounds like you, you've come to the right place. Your Impact You will work directly with client leaders and front-line operators to drive change that is critical to the successful realization of client company goals. In this role, you will be supporting healthcare providers with growing volume, optimizing price and capturing value. Our engagements are typically focused on growth solutions that leverage cutting edge assets and expertise, revenue cycle management capabilities across the value chain to ensure maximum value capture, or pricing capabilities that enable providers to excel along the full managed care contracting life cycle. Your clients will also include healthcare services companies and private equity organizations that partner with our provider clients. You will be working on topics such as growth operations, access and service line strategy and managed care. You will ensure that success is a priority with our clients. You will engage at a deep level across our clients' businesses, working with small teams to build the capabilities, systems, and processes needed to deliver bottom-line results and then ensure those results are sustainable. Your work will be about problem solving, coaching, and delivering lasting outcomes to our healthcare clients. Please note that there is flexibility to hire at the Senior Analyst or Specialist level, depending on the candidate's experience. Your Growth Driving lasting impact and building long-term capabilities with our clients is not easy work. You are the kind of person who thrives in a high performance/high reward culture - doing hard things, picking yourself up when you stumble, and having the resilience to try another way forward. In return for your drive, determination, and curiosity, we'll provide the resources, mentorship, and opportunities you need to become a stronger leader faster than you ever thought possible. Your colleagues-at all levels-will invest deeply in your development, just as much as they invest in delivering exceptional results for clients. Every day, you'll receive apprenticeship, coaching, and exposure that will accelerate your growth in ways you won't find anywhere else. When you join us, you will have: Continuous learning: Our learning and apprenticeship culture, backed by structured programs, is all about helping you grow while creating an environment where feedback is clear, actionable, and focused on your development. The real magic happens when you take the input from others to heart and embrace the fast-paced learning experience, owning your journey. A voice that matters: From day one, we value your ideas and contributions. You'll make a tangible impact by offering innovative ideas and practical solutions. We not only encourage diverse perspectives, but they are critical in driving us toward the best possible outcomes. Global community: With colleagues across 65+ countries and over 100 different nationalities, our firm's diversity fuels creativity and helps us come up with the best solutions for our clients. Plus, you'll have the opportunity to learn from exceptional colleagues with diverse backgrounds and experiences. World-class benefits: On top of a competitive salary (based on your location, experience, and skills), we provide a comprehensive benefits package, which includes medical, dental, mental health, and vision coverage for you, your spouse/partner, and children. Your qualifications and skills Undergraduate degree; advanced degree is a plus ideally in a quantitative discipline (statistics, mathematics, economics, operations research, engineering, computer science) or a healthcare discipline Ability to synthesize complex issues, engage senior leaders, and drive consensus Strong analytical skills in claims, productivity, access, and volume data to identify trends and opportunities 4+ years of professional experience in a healthcare environment with revenue growth or managed care experience - with experience in some of the following areas: Physician practice productivity, access operations, care continuity, and patient experience Experience expanding capacity, reducing wait times, and improving digital and front-end access (e.g., scheduling, call centers, online booking) Experience leading or supporting strategic growth of priority service lines (e.g., primary care, cardiology, oncology, surgery) through network expansion, site-of-care shifts, or population targeting Skilled in payer negotiations analytics, contract design, reimbursement modeling, and aligning incentives with system and service line priorities Experience partnering across clinical, operational, and administrative functions to execute enterprise-level initiatives Successful track record of delivering measurable impact through implementation of growth, access, and experience initiatives Please review the additional requirements regarding essential job functions of McKinsey colleagues. Apply Now Apply Later FOR U.S. APPLICANTS: McKinsey & Company is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by applicable law. Certain US jurisdictions require McKinsey & Company to include a reasonable estimate of the salary for this role. For new joiners for this role in the United States, including all office locations where the job may be performed, a reasonable estimated range is $125,000 - $130,000 USD -to help you understand what you can expect. This reflects our best estimate of the lowest to highest (salary/hourly wages) for this role at the time of this posting, ensuring you have a clear picture right from the start, though it's important to remember that actual salaries may vary. Factors like your office location, your unique blend of experience and skills, start date and our current organizational needs all play a part in determining the final figure. Certain roles are also eligible for bonuses, subject to McKinsey's discretion and based on factors such as individual and/or organizational performance. Additionally, we provide a comprehensive benefits package that reflects our commitment to the wellness of our colleagues and their families. This includes medical, mental health, dental and vision coverage, telemedicine services, life, accident and disability insurance, parental leave and family planning benefits, caregiving resources, a generous retirement contributions program, financial guidance, and paid time off. FOR NON-U.S. APPLICANTS: McKinsey & Company is an Equal Opportunity employer. For additional details regarding our global EEO policy and diversity initiatives, please visit our McKinsey Careers and Diversity & Inclusion sites. Job Skill Group - CSS Pre-Associate Job Skill Code - JPS - Junior Specialist Function - Transformation Industry - Healthcare Systems & Services Post to LinkedIn - Yes Posted to LinkedIn Date - Wed Jun 18 00:00:00 GMT 2025 LinkedIn Posting City - New York LinkedIn Posting State/Province - New York LinkedIn Posting Country - United States LinkedIn Job Title - Senior Analyst - Provider Revenue Excellence - Growth & Managed Care LinkedIn Function - Consulting;Health Care Provider;Strategy / Planning LinkedIn Industry - Hospital & Health Care LinkedIn Seniority Level - Associate #J-18808-Ljbffr

At MTM, we are not just colleagues; we are collaborators on a shared mission;communities without barriers. We have exciting opportunities to join our growing team where your work has a direct impact on the communities we serve. Our company culture is one of innovation, collaboration, and growth. If you are passionate, driven, and ready to join a team where your work will directly transform and shape our industry, then we want to talk to you! What will your job look like? The Manager, Regional Care Coordination (RCC) will be a leader, coach, mentor and subject matter expert. This position will assist in ensuring all Regional Care Coordinator team members are professionally trained, knowledgeable and assist with all aspects of reporting, workflows, and function oversight. The Manager, RCC is responsible for ensuring exceptional member service by leading a team of Care coordinators to focus on high need members and difficult to schedule trips, with a goal of no missed life sustaining trips or complaints. The Manager, RCC is responsible in monitoring all daily tasks to assure completion and drive a high level of member and client satisfaction through the Regional Care Coordinator Program. The Manager, RCC is also the primary point of contact for the Client to resolve escalated member issues. Location: Candidates located in the State of Missouri strongly preferred. This is a hybrid role if located within 40 miles of an MTM office location. What you’ll do: Supervise, motivate, assign, and monitor work, coordinate efforts, train, provide guidance etc. of staff and ensure company policies, procedures and standards of performance are being followed Serve as the Regional Care Subject Matter Expert, both internally and externally (Client facing role as well as direct relationships with Members/Beneficiaries/Participants, Program Directors, & Account Executives) Manage, develop and provide continuous coaching to staff in order to meet/exceed performance expectations and goals which include additional work outside traditional intake (templating and working with Vendor Account Managers/Dispatch to secure transportation) Provide Leadership with metrics, quality results, establish goals/targets, as well as focus on areas of opportunity; this includes ability to create and build Executive-level presentations/output Proactively interface with cross-functional personnel on all pertinent business issues which pertain to the Regional Care Program (e.g., Program Directors, Account Execs., Reporting Director, etc.) Partner with People & Culture to ensure staffing levels are adequate Develop incentives and engagement activities to foster teamwork, morale, and drive performance results Continuously review processes for efficiencies, improvement opportunities, and member satisfaction Participate in projects and assignments within MTM to develop processes/procedures that will drive efficiency, reduce cost, and create client satisfaction Direct responsibility for monitoring enrollment volume and report activity to ensure proper staffing coverage Act as a Brand Ambassador for MTM ensuring excellent customer service throughout departmental collaboration and communication Other duties as assigned What you’ll need: Experience, Education & Certifications: High School Diploma or G.E.D Minimum 5 years’ experience in an Operations role, preferrable in a leadership capacity 5+ years supervisory experience Contact center & Dispatch experience required Skills: Ability to maintain high level of confidentiality Excellent communication, presentation, and interpersonal skills Ability to motivate employees and peers Must possess the ability to handle multiple tasks simultaneously, maintain composure under pressure, and demonstrate a high customer service commitment Good organizational skills with attention to timeliness and details Ability to work independently and strategically Aptitude for effective use of Contact Center applications, and data analysis skills Strong level of proficiently in Microsoft Office Suite, including Microsoft Word and Excel Even better if you have. Bachelors Degree What’s in it for you: Health and Life Insurance Plans Dental and Vision Plans 401(k) with a company match Paid Time Off and Holiday Pay Maternity/Paternity Leave Casual Dress Environment Tuition Reimbursement MTM Perks Discount Program Leadership Mentoring Opportunities Salary Min: $65,440 Salary Max: $80,000 This information reflects the base salary pay range for this job based on current national market data. Ranges may vary based on the job's location. We offer competitive pay that varies based on individual skills, experience, and other relevant factors. We encourage you to apply to positions that you are interested in and for which you believe you are qualified. To learn more, you are welcome to discuss this with us as you move through the selection process. Equal Opportunity Employer: MTM is an equal opportunity employer. MTM considers qualified candidates with a criminal history in a manner consistent with the requirements of applicable local, State, and Federal law. If you are in need of accommodations, please contact MTM’s People & Culture. #MTM #J-18808-Ljbffr

Join the Porter Team as the Senior Director, Care Coordination Operations!

Porter is seeking a Senior Director of Care Coordination Operations (Care Management, Disease Management, Utilization Management) who is a strategic and operational leader. The Senior Director is responsible for delivering high-quality, efficient, and compliant care coordination services. This role oversees all aspects of Porter’s Care Coordination services, while leading the Care Guide Team to ensure exceptional member and client outcomes.

Key Responsibilities:

- Lead the development, implementation, and continuous improvement of care coordination capabilities to ensure optimal member engagement, outcomes, and client satisfaction.

- Oversee the Care Guide Team, fostering a culture of accountability, collaboration, and excellence in supporting members through the care continuum.

- Ensure seamless integration and alignment of all Porter Care Coordination programs with organizational priorities and regulatory requirements.

- Develop and execute data-driven performance metrics and operational KPIs to monitor effectiveness and drive results.

- Collaborate cross-functionally with clinical leaders, provider partners, and operational teams to ensure care delivery meets the highest standards of quality and efficiency.

- Stay current on regulatory changes, industry best practices, and innovative models of care to drive continuous improvement and innovation.

- Provide leadership, mentorship, and development opportunities for care coordination staff to enhance capabilities and engagement.

- Serve as a key partner to client stakeholders, ensuring that all services meet or exceed client expectations and contractual obligations.

Qualifications:

- Bachelor’s degree in nursing, social work, or related field; Master’s degree preferred.

- Active clinical licensure (e.g., RN, LCSW) strongly preferred.

- 8+ years of progressive leadership experience in care management, disease management, and/or utilization management within a complex health plan, provider, or integrated delivery system.

- Proven ability to lead large, multi-disciplinary teams and achieve measurable results.

- Deep knowledge of regulatory and accreditation standards (e.g., NCQA, CMS).

- Exceptional communication, collaboration, and problem-solving skills.

- Demonstrated commitment to patient-centered care and client partnership.

What Porter Offers

Remote Work Environment

Annual Salary

Benefits - effective within 30 days from start

Paid Holidays

Paid Time Off: Vacation + Sick

Strong Team Culture