Senior Director, Managed Care Contracting

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

📋 Description

• Establish, develop, and nurture positive working relationships with payer representatives and leadership within designated regions and/or projects.

• Collaborate with joint venture managed care and other colleagues to achieve joint managed care contracting and operational objectives.

• Lead the negotiation and execution of contracts with managed care payers and other third parties.

• Work alongside internal and external legal counsel to review, assess, and document payer contract language in compliance with departmental and regulatory standards.

• Conduct ad hoc reviews and analyses of contract language.

• Act as an internal resource for inquiries and requests regarding payer contract language.

• Collaborate with financial analysts and team members to prepare data and analyses for negotiations and to identify trends in claims or operational issues.

• Guide department team members in planning contract negotiations and renewals, including assessments of historical performance and identification of opportunities.

• Ensure the completion of contracting for newly acquired facilities and practices.

• Oversee the resolution of contract-related claims and operational issues with both internal and external customers, Managed Care Operations, and revenue cycle teams.

• Ensure that new and revised contract terms are communicated effectively to internal customers.

• Develop and maintain departmental tracking documents.

• Manage special projects and undertake other assigned responsibilities.

⛳️ Requirements

• A Bachelor's degree in Business Administration, Healthcare Administration, Finance, Law, or a related field is required.

• A Master's degree in Business Administration (MBA), Healthcare Administration (MHA), Public Health (MPH), or Juris Doctor (JD) is preferred.

• At least 10 years of progressively responsible experience in managed care contracting, payer relations, or healthcare reimbursement, including substantial experience in negotiating complex payer agreements.

• Minimum of 5 years of leadership experience with responsibilities for managing teams, projects, and organizational initiatives.

• Experience with hospitals, physician organizations, integrated delivery systems, or large multi-specialty healthcare organizations is preferred.

• Proven success in developing and executing contracting strategies that enhance reimbursement, operational performance, and organizational outcomes.

• Expert understanding of managed care contracting principles, payer reimbursement methodologies, and healthcare payment models, including fee-for-service, value-based reimbursement, and alternative payment arrangements.

• Extensive knowledge of commercial, Medicare Advantage, Medicaid managed care, and other third-party payer contracting practices.

• Strong understanding of healthcare regulatory requirements impacting managed care contracting, reimbursement, and compliance.

• Advanced skills in contract negotiation, drafting, interpretation, and analysis of contract language.

• Exceptional financial and analytical abilities with a capacity to evaluate reimbursement methodologies, identify trends, and formulate data-driven negotiation strategies.

• Proven ability to lead complex negotiations and influence both internal and external stakeholders to secure favorable outcomes.

• Strong skills in strategic planning, project management, and organization with the ability to manage multiple priorities and deadlines.

• Excellent written, verbal, and presentation communication abilities.

• Demonstrated ability to cultivate collaborative relationships across executive leadership, operations, finance, legal, revenue cycle, and clinical teams.

• Effective leadership, coaching, and team development skills, with experience in fostering a high-performing, collaborative work environment.

• Capacity to exercise sound judgment, maintain confidentiality, and make informed decisions in complex or sensitive situations.

• Proficiency in Microsoft Office applications, contract management systems, and healthcare financial and claims reporting tools.

🏝️ Benefits

• Comprehensive health insurance plans.

• Competitive salary and performance-based bonuses.

• Opportunities for professional development and continuing education.

• Supportive work environment with a focus on team collaboration.

• Flexible work arrangements and work-life balance initiatives.