Director of Managed Care and Contracting
Position Summary
The Director of Managed Care and Contracting is a senior leadership role responsible for developing, negotiating, and managing payor relationships and contracts across the organization’s service markets. This individual plays a pivotal role in ensuring patients receive uninterrupted access to high-quality care during periods of organizational change and growth, serving as a trusted liaison between the company and its managed care partners.
Key Responsibilities
Lead the negotiation, execution, and management of managed care contracts with commercial, Medicare Advantage, Medicaid, and other third-party payors.
Develop and maintain strong, trust-based relationships with payor representatives to ensure favorable contract terms and continuity of care.
Serve as the primary point of contact for payor escalations, audits, and contract renewals.
Monitor contract performance, reimbursement trends, and payor policy changes to proactively address risks and opportunities.
Champion patient continuity of care initiatives during transitions, acquisitions, or market changes, ensuring minimal disruption to patients and referring providers.
Collaborate cross-functionally with clinical, operations, and finance teams to align contracting strategies with patient care goals.
Identify and develop new payor relationships to expand network participation and market access.
Analyze reimbursement data, utilization trends, and payor performance metrics to inform negotiation strategies and organizational decision-making.
Prepare and present contract proposals, financial models, and managed care reports to senior leadership.
Stay current on regulatory changes, payor reimbursement methodologies, and industry best practices in managed care.
Provide guidance and oversight to managed care staff, delegating responsibilities appropriately and fostering a culture of accountability and continuous improvement.
Mentor team members and support their professional development and growth.
Build and maintain cross-departmental relationships to ensure organizational alignment on managed care objectives.