Regional Director, Managed Care

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

📋 Description

• Provide guidance to specialty provider practices regarding managed care contracting, payer strategies, reimbursement outcomes, market access, and management of payer relationships.

• Analyze, negotiate, and assist in the renewal of payer agreements.

• Create payer-specific strategies to enhance reimbursement, ensure access to specialty therapies, maintain operational sustainability, and achieve long-term goals for the practice.

• Assess contract terms, fee schedules, reimbursement methods, and payer-related challenges that could impact practice performance.

• Track changes in payer policies, reimbursement trends, and market developments; convert findings into actionable recommendations.

• Collaborate with provider practices to facilitate contract administration, reporting, payer communications, and the management of managed care initiatives.

• Draft summaries of payer strategies, negotiation points, and other resources to aid decision-making.

• Represent managed care contracting capabilities during meetings and business discussions.

⛳️ Requirements

• A bachelor's degree in finance, accounting, business, healthcare administration, or a related discipline; an advanced degree is preferred.

• Over 7 years of pertinent experience.

• At least 5 years of progressive experience in healthcare related to managed care contracting, payer relations, provider reimbursement, healthcare finance, or support for specialty practices.

• Proficiency in reviewing, interpreting, negotiating, or assisting with managed care contracts.

• Comprehensive understanding of healthcare reimbursement, payer policies, dynamics of commercial and government payers, network strategies, specialty markets, and concepts of value-based care.

• Capability to analyze performance data related to payers, reimbursement, and contracts and to transform insights into practical recommendations.

• Excellent written, verbal, presentation, negotiation, relationship management, and consultative skills.

• Ability to operate independently in a remote setting, manage multiple priorities, and support clients across diverse markets and payer environments.

• Proficient in Microsoft Word, Excel, PowerPoint, Salesforce.com, Smartsheet, and various analytical or reporting tools.

🏝️ Benefits

• Competitive compensation package.

• Opportunities for annual bonuses or long-term incentives.