Role Overview for Director of Managed Care
JRG Partners, a premier executive search firm specializing in healthcare recruitment, is proud to partner with a leading national healthcare organization in their search for an exceptional Director of Managed Care. This pivotal remote role offers a unique opportunity to shape the future of healthcare delivery by leading strategic managed care initiatives across a diverse portfolio of services. We are seeking a visionary and results-driven leader who can navigate the complex landscape of payer relations, contract negotiation, and value-based care models.
As the Director of Managed Care, you will be instrumental in developing and executing comprehensive strategies that enhance our client’s financial performance, improve patient outcomes, and strengthen relationships with health plans and governmental payers.
This role demands a strategic thinker with a deep understanding of the evolving healthcare market, a proven track record in contract management, and an unwavering commitment to operational excellence. You will be at the forefront of driving innovation in managed care, ensuring that our client remains competitive and continues to provide accessible, high-quality care to its communities.
This is more than just a management position; it is a leadership role that requires a blend of analytical prowess, negotiation finesse, and a collaborative spirit. You will be responsible for optimizing revenue streams, mitigating risks, and aligning managed care objectives with the organization’s broader strategic goals. If you are passionate about making a significant impact in the healthcare sector and thrive in a dynamic, challenging environment, we encourage you to explore this outstanding opportunity.
Key Responsibilities of Director of Managed Care
Strategic Planning & Execution
Develop, implement, and oversee comprehensive managed care strategies aligned with organizational goals, market trends, and regulatory changes. This includes identifying new opportunities for growth and efficiency within existing and emerging payment models.
Payer Contract Negotiation & Management
Lead and manage all aspects of payer contracting, including negotiation of rates, terms, and conditions with commercial health plans, Medicare Advantage plans, Medicaid Managed Care Organizations, and other third-party payers. Ensure contracts are financially viable and support long-term strategic objectives.
Performance Monitoring & Analysis
Establish and monitor key performance indicators (KPIs) for managed care contracts. Conduct in-depth financial and operational analysis to identify trends, areas for improvement, and opportunities for revenue optimization and cost reduction. Present findings and recommendations to senior leadership.
Relationship Management
Cultivate and maintain strong, collaborative relationships with key payer representatives, internal stakeholders (e.g., finance, operations, clinical, legal), and external partners. Serve as the primary point of contact for all managed care-related inquiries and issues.
Compliance & Regulatory Adherence
Ensure all managed care activities and contracts comply with federal and state regulations, including HIPAA, the Affordable Care Act (ACA), and specific managed care regulations. Stay current with policy changes and educate internal teams on their implications.
Team Leadership & Development
Recruit, mentor, and lead a high-performing team of managed care professionals. Foster a culture of accountability, continuous improvement, and professional growth. Provide guidance and support to ensure team objectives are met.
Value-Based Care Initiatives
Drive the development and implementation of value-based care programs, including accountable care organizations (ACOs), bundled payments, and other risk-sharing arrangements. Work to transition the organization towards models that reward quality and efficiency.
Market Intelligence & Competitor Analysis
Continuously monitor the healthcare market for new trends, competitor strategies, and innovative payment models. Provide insights and recommendations to maintain the organization’s competitive edge and adapt to evolving industry dynamics.
Denial Management & Appeals Oversight
Oversee strategies for effective denial management and appeals processes to maximize reimbursement and minimize revenue leakage. Collaborate with revenue cycle management teams to identify root causes and implement preventative measures.
Reporting & Communication
Prepare and present regular reports on managed care performance, contract status, and strategic initiatives to the executive team and board of directors. Communicate complex information clearly and concisely to diverse audiences.
Operational Integration
Work closely with operational leaders to ensure managed care contract terms are effectively integrated into clinical and administrative workflows, optimizing patient access, service delivery, and billing processes.
Technology & Data Utilization
Leverage data analytics, business intelligence tools, and managed care information systems to support strategic decision-making, contract performance, and reporting requirements.
Requirements for the Director of Managed Care
Education
Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or a related field required. A Master’s degree (MHA, MBA, MPH) is strongly preferred.
Experience
A minimum of 8-10 years of progressive experience in managed care leadership roles within a health system, hospital, large physician group, or health plan setting. This must include significant experience in payer contracting and negotiations.
Industry Knowledge
Deep and comprehensive understanding of various managed care models (HMO, PPO, ACO, MCO), commercial and governmental reimbursement methodologies, and healthcare finance principles.
Negotiation Expertise
Proven track record of successful contract negotiations with major payers, demonstrating the ability to secure favorable terms and achieve financial targets.
Analytical Skills
Exceptional analytical, quantitative, and problem-solving skills, with the ability to interpret complex data, identify trends, and develop strategic recommendations. Proficiency in financial modeling and scenario planning.
Leadership & Management
Demonstrated leadership abilities with experience managing and developing high-performing teams. Strong ability to influence, motivate, and collaborate effectively across all organizational levels.
Communication
Excellent written and verbal communication skills, including the ability to present complex information clearly and persuasively to executive leadership, board members, and external partners.
Regulatory Acumen
Thorough knowledge of current healthcare regulations, compliance requirements, and evolving payment reforms (e.g., value-based care, MACRA).
Technical Proficiency
Proficient in Microsoft Office Suite (Excel, PowerPoint, Word) and experience with managed care information systems, EHRs, and data analytics platforms.
Strategic Vision
Ability to think strategically, anticipate market changes, and develop proactive solutions to complex challenges in the managed care environment.
Relationship Building
Strong interpersonal skills with a knack for building and maintaining robust relationships with internal and external stakeholders.
Benefits & Perks Offered
Our client values their employees and offers a comprehensive benefits package designed to support your professional growth, personal well-being, and financial security. As the Director of Managed Care, you can expect:
Competitive Compensation
An attractive base salary commensurate with experience, along with performance-based bonuses tied to strategic achievements.
Comprehensive Health Coverage
Robust medical, dental, and vision insurance plans for you and your family, ensuring access to quality healthcare.
Generous Paid Time Off
Ample vacation, sick leave, and paid holidays to support work-life balance and personal rejuvenation.
Retirement Savings
A strong 401(k) retirement plan with a generous company match, helping you plan for your financial future.
Professional Development
Opportunities for continuing education, industry conferences, certifications, and leadership training to foster your ongoing career advancement.
Flexible Work Environment
The advantage of a remote work setup, providing flexibility and autonomy while maintaining strong team collaboration.
Life & Disability Insurance
Company-paid life insurance and short-term/long-term disability coverage for added peace of mind.
Wellness Programs
Access to employee wellness initiatives focused on physical, mental, and emotional health.
Impactful Work
The chance to play a critical role in a leading healthcare organization, directly influencing patient care and organizational success.
How to Apply
If you are a highly motivated and experienced managed care leader ready to take on a challenging yet rewarding remote role, we invite you to apply. Please submit your resume and a compelling cover letter outlining your qualifications and why you are the ideal candidate for this Director of Managed Care position. Highlight your experience in contract negotiation, strategic planning, and team leadership.
To learn more about JRG Partners and our expertise in connecting top talent with leading healthcare organizations, visit our dedicated Healthcare Recruitment practice area page. We look forward to reviewing your application and exploring how your skills and experience align with this outstanding opportunity.
