Managed Care Director

Position Overview:
The Managed Care Director is responsible for overseeing and optimizing managed care contracts, reimbursement strategies, and payer relationships to ensure financial sustainability and compliance. This role involves negotiating contracts with insurance providers, analyzing reimbursement trends, and developing strategies to enhance operational efficiency within the managed care framework.

Key Responsibilities:

Contract Negotiation & Management

• Develop and negotiate managed care contracts with insurance companies, HMOs, PPOs, and other payers.
• Ensure contracts align with organizational financial goals and compliance standards.
• Monitor contract performance, reimbursement rates, and financial impact.

Financial & Reimbursement Strategy

• Analyze reimbursement trends and payer policies to identify risks and opportunities.
• Develop strategies to optimize revenue cycle management and payment structures.
• Collaborate with finance and billing teams to enhance reimbursement processes.

Compliance & Regulatory Oversight

• Ensure all managed care activities comply with federal, state, and payer regulations.
• Stay updated on changes in healthcare laws, reimbursement models, and compliance requirements.
• Work closely with legal and compliance teams to mitigate risks.

Payer Relations & Stakeholder Engagement

• Maintain strong relationships with payers, providers, and regulatory agencies.
• Serve as the primary liaison between the organization and managed care entities.
• Communicate contract terms and reimbursement policies effectively across departments.

Operational & Strategic Leadership

• Develop and implement strategies to improve managed care efficiencies and financial performance.
• Provide leadership and guidance to staff involved in managed care operations.
• Collaborate with cross-functional teams, including finance, revenue cycle, and clinical departments, to align managed care initiatives with organizational goals.

Plus – may perform other duties as assigned.

Education:

• Bachelor’s degree in healthcare administration, business, finance, or a related field (Master’s preferred).

Experience:

• Minimum of 5–7 years of experience in managed care contracting, reimbursement, or healthcare finance.
• Previous leadership or management experience in a healthcare setting.

Key Competencies:

• Strong understanding of managed care principles, reimbursement models, and payer contract structures.
• Excellent negotiation, analytical, and financial acumen.
• Knowledge of federal and state healthcare regulations, including Medicare and Medicaid policies.
• Strong leadership and communication skills, with the ability to collaborate across departments.
• Proficiency in data analysis, financial modeling, and healthcare revenue cycle management.

Preferred Qualifications:

• Experience working with hospital systems, physician groups, or insurance companies.
• Familiarity with value-based care models and alternative payment structures.
• Certification in healthcare finance or managed care (e.g., HFMA CHFP, ACMPE, or CPC).

Working Conditions:

• Standard office environment.
• Occasional travel within Southern California may be required.
• Full-time position with standard business hours; flexibility to work additional hours during peak periods is expected.

Equal Opportunity Employer:
We are an equal opportunity employer committed to diversity and inclusion. We celebrate diversity and are dedicated to fostering an inclusive environment for all employees.