Job Title: Manager of Health Plan Contracting

Location: Hybrid position requiring periodic on-site presence at Antidote’s office

Department: Operations

Reports To: Director of Managed Care - Operations

BACKGROUND

Antidote Health believes healthcare is a basic human right. Our mission is to redefine healthcare by providing affordable, high-quality, accessible care and insurance products. We offer telehealth services in several states and ACA-compliant health insurance plans in Ohio and Arizona, with plans to expand. Our "virtual-first" approach integrates with in-person care and features $0 Antidote virtual provider visits, low to no copay for in-person visits, and $0 medication benefits. If you are an experienced, mission-driven team member who can flex and adapt to the shifting circumstances of a growth-stage startup and are passionate about care quality, lowering healthcare costs, and improving health and financial outcomes for members, Antidote has a great opportunity.

JOB SUMMARY

The Manager of Health Plan Contracting (“Manager”) is responsible for managing provider contracting for Antidote’s health plans. This includes negotiation and execution of provider agreements, compliance with CMS, ACA Marketplace, and state-specific requirements, and support for ongoing provider network management activities.

The Manager partners cross-functionally with legal, compliance, finance, and network development teams to develop, execute, and maintain contracts that ensure access, quality, and value. The role also involves ensuring data integrity in provider and contract systems, managing renewals and amendments, supporting regulatory filings, and implementing contracting strategies that align with Antidote’s operational and financial objectives.

KEY RESPONSIBILITIES

• Manage end-to-end provider contracting processes for physicians, hospitals, ancillary providers, and delegated entities.
• Negotiate contract terms, rates, and value-based payment models consistent with Antidote’s network and financial goals.
• Manage relationships and performance of third-party contracting partners or vendors, ensuring service-level adherence, data accuracy, and compliance with Antidote’s contracting standards and regulatory obligations.
• Collaborate with Legal, Compliance, and Network Development to ensure provider agreements meet CMS, ACA Marketplace, and state-specific regulatory requirements.
• Maintain an organized repository of executed agreements, amendments, approved alternate contract language, and key contract metadata in alignment with operational workflows.
• Develop, negotiate, and draft Single Case Agreements (SCAs) and Letters of Agreement (LOAs) for out-of-network or case-specific services, ensuring appropriate reimbursement terms, utilization controls, and compliance with applicable regulations.
• Coordinate with Network Development and Credentialing to ensure seamless onboarding and network integration of contracted providers.
• Support network adequacy filings, access reports, and regulatory submissions related to contracting.
• Review, update, and maintain contracting policies, procedures, and templates.
• Develop and track key performance indicators (KPIs) for contracting turnaround time and compliance.
• Lead or support internal and external audits related to provider contracting.
• Support development and implementation of new provider programs, incentive arrangements, and payment methodologies.
• Participate in system implementations and data integrations affecting provider and contract records.

QUALIFICATIONS

The requirements listed below represent the necessary knowledge, skills, and abilities. Reasonable accommodations can be made to enable individuals with disabilities to perform the essential functions.

• Bachelor’s degree in Healthcare Administration, Business, or a related field preferred.
• Equivalent combination of education and progressively responsible experience in health plan provider contracting, managed care, or network development may be considered in lieu of degree.
• Minimum of 5 years of progressive experience in health plan provider contracting, network development, or managed care operations.
• At least 2 years of supervisory or team leadership experience preferred.
• Demonstrated experience negotiating provider contracts and managing value-based or risk-sharing arrangements.
• Familiarity with CMS and ACA Marketplace contracting requirements and state-level regulatory standards.
• Strong understanding of network adequacy and provider reimbursement methodologies.
• Excellent analytical, communication, and organizational skills.
• Experience with contract management systems or provider data platforms preferred.

SKILLS AND COMPENTENCIES

• Comprehensive understanding of CMS, ACA Marketplace, and state-specific network and contracting regulations.
• Ability to interpret and apply regulatory and contractual requirements to network operations.
• Strong negotiation and relationship-management skills with provider groups and vendors.
• Proficiency in developing, implementing, and monitoring provider contracting policies and workflows.
• Experience conducting contract related audits and preparing for regulatory reviews.
• Ability to create corrective action plans and monitor compliance metrics.
• Competence in using data and KPIs to implement process improvements.
• Strong cross-functional collaboration with Legal, Compliance, Finance, and Network Development teams.
• Proven ability to manage multiple priorities in a fast-paced, growth-stage environment.
• Build and maintain positive working relationships with internal and external stakeholders.

WORK ENVIRONMENT

• Hybrid position requiring periodic on-site presence at Antidote’s office.
• Must have a quiet, distraction-free workspace to perform duties effectively from home.
• Work location must be secure and private to maintain HIPAA compliance.
• This position may require travel.