Senior Value Based Care Contract Specialist

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Job Title:

Senior Value Based Care Contract Specialist

Department:

Health System Shared Services | Financial Administration

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 improve OSUHSs ability to compete in a managed care environment. 

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.

Position Summary:

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. While negotiation is the primary focus, the position also requires a 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.

As the organization’s expert in managed care, CMS, and Ohio Medicaid regulatory requirements, the Senior Contract Specialist serves as the primary resource for value‑based payment structures, compliance expectations, and emerging payer strategies. The position interprets and operationalizes Ohio Medicaid managed care regulations, with specific expertise in the Comprehensive Integrated Care Incentive Program (CICIP). Responsibilities include leading organizational readiness, compliance alignment, and internal education on CICIP program design, performance metrics, incentive methodologies, data submission requirements, and provider performance expectations.

In Financial and Performance Reporting, the position partners with analytic stakeholders to ensure contract terms are accurately modeled, tracked, and evaluated throughout the performance cycle. The specialist oversees the development of dashboards and reporting that quantify contract performance, incentive opportunities, and financial exposure. The role uses these insights to guide negotiation strategy, performance improvement recommendations, and long‑term value‑based care planning.

Strong Cross‑Functional Collaboration is essential, a