Managed Care Contracting Manager - Irvine - True Behavioral Health LP

Description

First Responder Health is dedicated to serving those who serve others.

Through our family of companies, we provide comprehensive, proactive, and reactive wellness and resilience resources exclusively for public safety professionals.

Our mission is to support first responders in maintaining their mental health and well-being throughout their demanding careers.

Our family of companies includes:

• The Counseling Team International - Culturally competent short-term counseling, critical incident debriefings, training, and pre-employment psychological testing
• First Responder Wellness - Comprehensive inpatient and outpatient behavioral health treatment exclusively for public safety professionals, treating post-traumatic stress, alcohol addiction, anxiety, and depression
• Shift Wellness - Retreats for trauma, resilience, and wellness specially designed for leaders, peer support teams, individuals, departments, and spouses

What sets us apart is our deep understanding of first responder culture.

Our clinical and support staff includes former first responders who are intimately familiar with the unique challenges public safety professionals face.

We are committed to destigmatizing mental wellness and providing culturally competent care in a safe, supportive environment.
Position Summary

The Managed Care Contracting Manager exercises independent judgment and discretion in managing First Responder Health's payer contracting operations and strategic enrollment portfolio.

This position has direct responsibility for critical business decisions affecting revenue cycle optimization, payer relationship management, and operational compliance across all First Responder Health entities, including First Responder Wellness, The Counseling Team International, and Shift Wellness.

This role independently analyzes complex payer requirements, develops and implements contracting strategies, makes authoritative determinations on enrollment priorities and credentialing approaches, and exercises significant autonomy in resolving payer-related operational issues that directly impact organizational revenue and compliance.

The Manager serves as the subject matter expert for payer operations and independently manages the full lifecycle of payer relationships with minimal supervision.

Essential Functions Requiring Discretion and Independent Judgment
Strategic Payer Portfolio Management

• Independently evaluate and prioritize payer enrollment opportunities based on strategic value, revenue potential, operational capacity, and market conditions; make authoritative recommendations to Controller and CEO on which payers to pursue, maintain, or terminate
• Exercise independent judgment in analyzing payer contract terms, fee schedules, and requirements; identify favorable and unfavorable provisions and recommend negotiation strategies or contract modifications
• Develop and implement comprehensive enrollment strategies for new service lines and facilities, determining optimal timing, sequencing, and resource allocation with minimal oversight
• Make independent determinations regarding payer credentialing approaches, documentation requirements, and compliance strategies for complex multi-entity healthcare organizations

Contract Administration and Compliance Oversight

• Exercise discretion in interpreting complex payer contract terms, policy updates, and regulatory requirements; independently determine operational implications and necessary organizational responses
• Independently manage the contract renewal process, including evaluating contract performance, identifying concerns or opportunities, and making recommendations on renewal terms or renegotiation priorities
• Establish and maintain systems for contract documentation, version control, and organizational access; exercise judgment in determining what information requires distribution and to whom
• Independently assess compliance risks related to payer requirements and enrollment status; determine and implement corrective actions to mitigate identified risks

Credentialing and Enrollment Lifecycle Management

• Exercise independent judgment in managing complex credentialing applications, determining required documentation, resolving discrepancies, and making decisions on application strategy to optimize approval likelihood
• Independently troubleshoot and resolve credentialing delays, denials, or issues by analyzing root causes, determining appropriate escalation strategies, and implementing solutions
• Make authoritative determinations on credentialing priorities based on business needs, provider availability, service demands, and revenue projections
• Develop and maintain comprehensive tracking systems for enrollment status, revalidation timelines, and compliance deadlines; independently determine monitoring protocols and intervention thresholds

Cross-Functional Leadership and Operational Problem-Solving

• Serve as authoritative resource for payer-related inquiries from Admissions, Revenue Cycle, Utilization Review, and clinical departments; independently resolve complex questions requiring interpretation of contract terms, coverage policies, or enrollment status
• Exercise discretion in coordinating with Revenue Cycle Supervisor to resolve billing issues related to enrollment, fee schedules, or payer requirements; independently determine appropriate resolution strategies and implementation approaches
• Make independent decisions regarding payer communications, including determining what information to share with external payers, appropriate communication channels, and escalation protocols for unresolved issues
• Independently support new program development by analyzing payer landscape, identifying enrollment requirements and barriers, and developing recommendations for payer engagement strategies

Data Systems and Business Intelligence

• Exercise independent judgment in designing and maintaining payer data infrastructure across NetSuite, Avea Office, and Kipu systems; determine data requirements, validation protocols, and system configuration approaches
• Independently develop and maintain payer dashboards, enrollment tracking systems, and contract status reports; determine appropriate metrics, reporting frequency, and distribution protocols
• Analyze payer rate structures and reimbursement trends; make independent recommendations to Controller regarding fee schedule updates, rate negotiations, or revenue optimization opportunities
• Independently audit payer data for accuracy and completeness; determine correction priorities and implement systematic improvements to data quality

Payer Relationship Management and Strategic Communications

• Serve as primary point of contact for payer representatives on administrative, operational, and enrollment matters; exercise discretion in responding to payer inquiries and managing ongoing relationships
• Independently evaluate payer policy updates, network changes, and program modifications; determine organizational impact and coordinate implementation of necessary operational responses
• Make independent decisions regarding escalation of payer issues to Controller or CEO based on strategic significance, financial impact, or resolution complexity
• Provide strategic support for contract negotiations by preparing comparative analyses, identifying negotiation leverage points, and recommending positions on key contract terms

Required Qualifications

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field; or equivalent combination of education and professional experience in healthcare payer operations
• Minimum 3-5 years of progressive experience in payer enrollment, contract administration, managed care operations, or healthcare revenue cycle management with demonstrated independent decision-making authority
• Proven expertise in behavioral health or medical billing, credentialing processes, and payer operations with demonstrated ability to work autonomously on complex projects
• Advanced proficiency in Excel, database management, and healthcare information systems; ability to independently develop complex reporting and tracking systems
• Excellent analytical, problem-solving, and communication skills with demonstrated ability to interpret complex contracts and make strategic recommendations to senior leadership

Preferred Qualifications

• Direct experience with NetSuite ERP, Avea Office, and Kipu EMR systems
• Demonstrated expertise in California workers' compensation, third-party administrators (TPAs), commercial payers, and Employee Assistance Programs (EAPs)
• Advanced understanding of utilization management (UM) requirements and behavioral health authorization processes

Core Competencies

• Strategic Thinking and

Business Judgment:
Ability to analyze complex situations, evaluate alternatives, and make sound independent decisions that align with organizational objectives and industry best practices

Autonomy and Self-Direction:
Demonstrated capacity to work independently with minimal supervision, setting own priorities and managing complex projects from inception through completion

Analytical Excellence:
Strong quantitative and qualitative analysis skills with ability to synthesize complex data, identify patterns and trends, and develop actionable insights

• Attention to Detail and Accuracy: Exceptional organizational skills with consistent accuracy in managing complex documentation, contracts, and compliance requirements

Professional Communication:
Excellent written and verbal communication skills; ability to explain complex concepts clearly to diverse audiences and represent the organization professionally with external payers

Adaptability and Problem-Solving:
Resourceful approach to challenges; ability to independently troubleshoot issues, develop creative solutions, and adapt strategies based on changing circumstances
Working Conditions and Physical Requirements

• This position is primarily office-based with standard business hours; occasional flexibility required for payer meetings or time-sensitive credentialing deadlines
• Extensive computer work requiring prolonged periods of sitting and visual concentration
• May require occasional travel to payer offices, industry conferences, or other FR Health locations