Director - Managed Care

Position Summary:

The Director of Managed Care is responsible for leading managed care contracting, payer relations, contract compliance, and reimbursement analysis activities. This role partners closely with executive leadership to negotiate and administer managed care agreements, optimize payer reimbursement performance, and ensure organizational compliance with contract terms and credentialing requirements. The Director oversees managed care operations, contract audit functions, payer credentialing activities, staff performance, and departmental budgeting while serving as a key liaison between the organization and commercial, government, and managed care payers. The position also provides leadership in contract modeling, financial analysis, policy development, and operational oversight to maximize revenue integrity and support organizational financial goals.

Key Responsibilities

• Lead and support managed care contract negotiations and payer relationship management.

• Direct payer credentialing activities, including interactions with managed care organizations and TennCare.

• Oversee contract compliance monitoring, reimbursement modeling, and contract performance audits.

• Analyze managed care agreements and reimbursement methodologies to identify financial opportunities and risks.

• Manage daily operations of the Managed Care and Contract Audit department.

• Develop and implement departmental policies, procedures, and performance standards.

• Supervise staff, conduct performance evaluations, and support employee development.

• Prepare, monitor, and manage departmental budgets and operational reports.

• Collaborate with executive leadership to address payer issues, contract strategy, and revenue optimization initiatives.

Position Qualification:

Bachelor's degree and 3-5 years of related managed care, payer contracting, healthcare finance, or equivalent experience preferred. Requires strong analytical, communication, leadership, contract negotiation, and relationship management skills.