Our client, a prominent healthcare organization committed to innovative patient care and operational excellence, is hiring a Director of Managed Care and Payor Strategy. The Director of Managed Care and Payor Strategy plays a pivotal role in negotiating and managing managed care contracts, optimizing payer relationships, and ensuring contractual compliance across hospital and physician enterprise operations. This leadership position requires a strategic thinker with deep expertise in payer markets, contract negotiations, and healthcare payment models. The successful candidate will shape the organizations payer strategy, drive contract performance, and support growth initiatives, particularly in outpatient and specialty services such as oncology.
Responsibilities
- Lead negotiation of managed care and physician contracts, ensuring favorable rates and terms that align with organizational growth plans.
- Analyze payer contracts and claims data to identify payment discrepancies, opportunities for rate adjustments, and process improvements.
- Serve as primary liaison with payers on claims issues, process concerns, and contractual obligations, fostering strong payer relationships.
- Develop and implement strategic plans to transition toward value-based care models while managing existing fee-for-service arrangements.
- Oversee contract management for hospital and physician enterprise agreements, ensuring consistency and co-termination where appropriate.
- Collaborate with clinical, finance, and revenue cycle teams to optimize payer mix and reimbursement strategies.
- Monitor industry trends, payer market shifts, and regulatory changes to adapt and refine organizational strategies accordingly.
- Supervise a team of analysts, providing guidance, training, and support to ensure contract performance and compliance.
Requirements
- Minimum of 5 years of experience in managed care contracting, payor strategy, or healthcare revenue cycle management.
- Demonstrated expertise in negotiating contracts with commercial payers, Medicaid Managed Care, and Medicare Advantage plans.
- Strong analytical skills with the ability to interpret complex contract language and claims data.
- Excellent negotiation, communication, and interpersonal skills.
- Ability to work cross-functionally and manage multiple priorities in a fast-paced environment.
- Knowledge of healthcare payment models, including value-based care and alternative payment arrangements.
- Proficiency in contract management software and data analysis tools.
- Experience working within a hospital or health system of similar size and complexity preferred.
- Familiarity with outpatient care, oncology program growth strategies, and Medicare Advantage products preferred
- Certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Revenue Cycle Executive (CRCE) are a plus.
- Bachelors degree in healthcare administration, finance, or a related field; Masters degree preferred.
Take the next step in your career by contributing your expertise to a forward-thinking healthcare organization. If you meet these qualifications and are eager to impact healthcare delivery and reimbursement strategies, apply now to join this dynamic team.
Salary: The posted range is not a guarantee. The actual salary will be based on qualifications, experience, and education and could fall outside of this range. Contact us for more information.
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