Director of Managed Care

Key Responsibilities

• Leads all day‑to‑day managed care operations, serving as the primary operational point of accountability for contracting activities, payer issue resolution, and contract performance oversight.
• Executes hospital and physician contracting efforts—including negotiation of rates, terms, and contract language—based on strategic direction and priorities set by the VP and executive leadership.
• Oversees and directs the financial modeling and contract performance analysis process, ensuring that all analyses support negotiation activities and reflect organizational expectations.
• Ensures all aspects of the negotiation lifecycle are completed thoroughly and accurately, including data preparation, modeling, terms review, internal alignment, finalization, and implementation.
• Collaborates closely with Revenue Cycle, Finance, Population Health, and other stakeholders to ensure negotiated terms are implemented correctly and that ongoing performance aligns with expected financial and operational outcomes.
• Provides operational leadership, guidance, and support to Managed Care staff, ensuring daily work is aligned with department goals and Medical Center strategy.
• Monitors contract performance on an ongoing basis, identifies variances, and initiates corrective actions in coordination with internal stakeholders and under VP direction.

Requirements

• Bachelor’s degree required; Master’s preferred.
• 7–10 years of managed care contracting experience within a hospital or health system.
• Strong negotiation, financial analysis, and communication skills.
• Experience with value‑based care models and reimbursement methodologies.