Contract Governance Manager

Job Purpose

Responsible for establishing, implementing, and overseeing the contract governance framework across all payer agreements to ensure compliance, operational effectiveness, financial integrity, and risk mitigation. The role ensures that contract lifecycle management processes, controls, policies, and performance monitoring mechanisms are consistently applied and aligned with organizational objectives, regulatory requirements, and healthcare reimbursement standards

Roles and Responsibilities

Organizational Accountabilities

• Ensure work is performed based on approved policies, processes, procedures, and instructions
• Identify opportunities for continuous improvement of systems, processes and practices considering leading practices, cost reduction and productivity improvement
• Ensure day-to-day activities are properly performed in line with policies and procedures
• Follow-up on escalated cases/issues of subordinates to ensure they are closed efficiently and in a timely manner

Functional Accountabilities

A. Contract Governance & Framework Management

• Develop and maintain the organization's contract governance framework, policies, standards, and procedures.
• Ensure consistency in contract structure, approval workflows, delegation of authority, and documentation requirements.
• Establish governance controls for contract lifecycle management from negotiation through renewal and termination.
• Lead governance reviews to ensure adherence to organizational contracting standards.

B. Compliance, Risk & Regulatory Oversight

• Ensure compliance with CCHI, NPHIES, MOH, legal, and internal governance requirements.
• Identify, assess, and mitigate contractual, operational, financial, and regulatory risks.
• Oversee contract audit readiness and coordinate internal and external audits.
• Monitor regulatory changes and ensure timely updates to contracting practices.

C. Contract Performance & Value Realization

• Establish KPIs and governance metrics to monitor payer contract performance.
• Lead periodic contract performance reviews with internal stakeholders and payers.
• Identify revenue leakage risks and recommend corrective actions.
• Drive contract optimization initiatives to maximize reimbursement and operational efficiency.

D. Governance Committees & Stakeholder Management

• Chair or coordinate Contract Governance Committees and review forums.
• Serve as the primary escalation point for high-impact contractual disputes and governance issues.
• Collaborate with Finance, Revenue Integrity, Legal, Compliance, and Operations teams.
• Support executive leadership with governance insights and strategic recommendations.

E. Contract Lifecycle Oversight

• Oversee contract drafting, review, approval, execution, amendments, renewals, and termination processes.
• Ensure complete contract repository management and document retention compliance.
• Monitor contract obligations, milestones, and renewal timelines.

F. Reporting, Analytics & Continuous Improvement

• Develop governance dashboards and executive reports.
• Analyze payer performance, reimbursement trends, compliance indicators, and contractual risks.
• Lead continuous improvement initiatives related to contract governance processes and systems.
• Benchmark governance practices against healthcare industry standards.

G. Leadership & People Management

• Lead and develop Contracting Specialists and Contracting Supervisors.
• Establish departmental objectives, KPIs, and development plans.
• Foster a culture of accountability, compliance, and continuous improvement.

Key Contacts

Key Internal Stakeholders:

• Contracting Manager / Pricing & Contracting Director
• Pricing, Billing, Coding, Denials, and Revenue Integrity Teams
• Finance & Costing
• Legal & Compliance
• IT / HIS & NPHIES Teams
• Internal Audit

Key External Stakeholders:

• Insurance Companies and TPAs
• Council of Cooperative Health Insurance (CCHI)
• NPHIES Platform Representatives
• External Auditors and Consultants