Director, Managed Care

This is a fully remote position, open to applicants in United States.

📋 Description

• Lead and enhance strategic collaborations with Managed Care Organizations, post-acute providers, and health systems.

• Drive new business initiatives and revenue through clinical integration and market expansion.

• Negotiate alternative payment structures, risk-sharing arrangements, and reimbursement strategies.

• Provide support and direction to Operations, Sales, Billing, and Finance teams.

• Ensure prompt and precise establishment and upkeep of contracts with payors, facilities, subcontractors, and other entities.

• Oversee and contribute to RFP processes.

• Resolve intricate issues with minimal supervisory oversight.

• Act as a subject matter expert on contract and reimbursement matters relevant to the home medical equipment and healthcare sectors.

• Manage a client portfolio while delivering business opportunities and overseeing projects.

• Collaborate with Audit and Compliance to uphold good standing with entities, regulations, and patients.

• Assess and manage TPA integration alternatives.

• Stay informed about current HME products and services.

• Safeguard patient confidentiality in accordance with HIPAA and complete necessary compliance training.

• Select, recruit, onboard, train, mentor, counsel, and evaluate staff members.

• Set departmental objectives that align with the organization's strategic goals.

• Meet performance and retention objectives and conduct performance evaluations.

⛳️ Requirements

• Bachelor's degree in a relevant field from an accredited institution is required.

• A minimum of seven (7) years of pertinent work experience in contracting, credentialing, or network management is required.

• Preferred: Five (5) years of management experience in a related role.

• A valid and unrestricted driver's license in the state of residence is required.

• Demonstrated leadership capabilities.

• Proficient in managing complex contract negotiations.

• Strong understanding of medical contracting methodologies and claims pricing/reimbursement strategies.

• Ability to think independently and make informed decisions.

• Exceptional analytical and problem-solving skills with a keen attention to detail.

• Excellent verbal and written communication skills.

• Competent computer skills, particularly in Microsoft Office, with a focus on Excel.

• Capable of prioritizing and managing multiple projects effectively.

• Technical proficiency to comprehend data flow through systems and their interactions.

🏝️ Benefits

• Comprehensive health insurance plans.

• Retirement savings options with employer matching.

• Generous paid time off and holidays.

• Opportunities for professional development and training.

• Supportive work environment that encourages work-life balance.