Director of Managed Care and Contracting

This is a fully remote position, open to applicants in Idaho, +3 more states.

📋 Description

• Oversee the negotiation, execution, and management of managed care agreements with commercial, Medicare Advantage, Medicaid, and various other third-party payors.

• Establish and nurture relationships with payor representatives.

• Act as the primary liaison for payor escalations, audits, and contract renewals.

• Track contract performance, reimbursement trends, and changes in payor policies.

• Advocate for patient continuity of care during transitions, acquisitions, or shifts in the market.

• Collaborate with clinical, operations, and finance teams.

• Identify and cultivate new payor relationships to enhance network participation and market access.

• Assess reimbursement data, utilization patterns, and payor performance indicators.

• Prepare and deliver contract proposals, financial models, and managed care reports to senior leadership.

• Stay informed on regulatory updates, reimbursement methods, and best practices in managed care.

• Provide direction and supervision to managed care staff.

• Mentor team members and encourage their professional growth.

• Develop and maintain interdepartmental relationships.

⛳️ Requirements

• A bachelor’s degree in healthcare administration, business, or a related field is required; an advanced degree is preferred.

• A minimum of 7 years of progressive experience in managed care contracting and payor relationship management.

• Previous experience in respiratory therapy, home medical equipment (HME), or related healthcare services is strongly preferred.

• Proven track record of successfully negotiating complex managed care agreements with both commercial and government payors.

• Comprehensive understanding of payor reimbursement methodologies, fee schedule structures, and managed care regulatory frameworks.

• Outstanding negotiation skills.

• Strong analytical capabilities and adeptness at interpreting data and converting insights into actionable strategies.

• Excellent written and verbal communication skills.

• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, SharePoint).

• Capacity to manage multiple priorities and meet competing deadlines.

• Willingness to travel up to 50% within the assigned region/territory as necessary.

• A valid state driver’s license in the state of residence; must adhere to Motor Vehicle policy requirements.

• Reliable transportation is required.

🏝️ Benefits

• Full-time employment.

• Fully remote position.

• Opportunities for travel within the assigned region/territory (up to 50%).