Director, Managed Care – Great Lakes Region

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

📋 Description

• Spearhead and enhance strategic alliances with Managed Care Organizations, post-acute providers, and healthcare systems.

• Generate new business and revenue through clinical integration and market development.

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

• Direct cross-functional team members across Operations, Sales, Billing, and Finance.

• Ensure prompt and precise contract establishment and ongoing management with payors, facilities, subcontractors, and other legal entities.

• Lead and support the RFP process.

• Address complex issues with minimal managerial oversight.

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

• Oversee a client portfolio to identify and exploit business opportunities and projects.

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

• Assess and supervise TPA integration options.

• Maintain familiarity with the company’s HME products and services.

• Safeguard patient confidentiality and adhere to HIPAA regulations.

• Complete compliance training and mandatory educational programs.

• Recruit, onboard, train, coach, counsel, and evaluate team members.

• Set departmental goals and objectives that align with organizational strategy.

• Meet organizational performance and retention targets.

⛳️ Requirements

• Demonstrated leadership capabilities.

• Capacity to manage complex contract negotiations.

• In-depth knowledge of medical contracting methodologies and claims pricing/reimbursement strategies.

• Independent thinker and decision-maker.

• Strong analytical and problem-solving abilities with a keen attention to detail.

• Exceptional verbal and written communication skills.

• Strategic business partner.

• Proficient in computer skills and familiar with Microsoft Office, particularly Excel.

• Ability to prioritize and handle multiple projects effectively.

• Solid aptitude for learning new technologies and comprehending data flow through systems and their interactions.

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

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

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

• Valid and unrestricted driver’s license in the state of residence.

🏝️ Benefits

• Comprehensive health and wellness programs.

• Competitive salary and performance-based incentives.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on work-life balance.