Operations Specialist Managed Care - Contracting & Payor Relations

  • Full-time
  • Job Shift: Day Job (1st)

Company Description

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?

Job Description

The Managed Care Specialist reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.


  • Works with Patient Accounting, Case Management and Admitting and Registration to implement managed care contracts.
  • Works with Sr. MC Specialist to ensure contracts are loaded correctly by NM and Payer and executed in a timely fashion.
  • Responsible for distribution of all important contracting documents to appropriate parties.
  • Involved in coordination of all orientations and implementation meetings between internal groups and Payer.
  • Meets with Senior Contracting team regularly to report status updates on all contracting activity and special projects.
  • Responsible for handling all contracts operational issues resulting in nonpayment or denials of payment.
  • Responsible for all single case letters for general medical care.
  • Responsible for contracting with IPA/PHO capitated business in conjunction with NMFF.
  • Coordinates RFI process for Centers of Excellence participation with specialty services as well as handling credentialing process for payors when needed.
  • Performs special projects as duties as assigned by the Director, Managed Care.
  • AA/EOE.



  • Bachelor's degree or minimum of 3 years of relevant experience.
  • Excellent written and oral communications skills are necessary.
  • Strong organizations skills and experience with managed care contracting is essential.
  • Proficiency in data analysis.


  • 5+ years of relevant experience in a managed care organization, consulting firm, hospital system/hospital.

Additional Information

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.