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The Director of Managed Care is responsible for providing strategic leadership and oversight of the hospital system's managed care operations, payer contracting, reimbursement strategies, and provider network relationships. This position develops and executes contracting strategies that maximize reimbursement, improve financial performance, expand market access, and support organizational growth. The Director serves as the primary executive liaison with commercial, government, and employer-sponsored health plans while ensuring compliance with contractual, regulatory, and accreditation requirements. The Director collaborates closely with Chief Business Development Officer and executive leadership to develop value-based care initiatives, optimize contract performance, and support the organization's strategic objectives.
Reports To: Chief Business Development Officer
Job Specific Responsibilities
Daily assignments may include but are not limited to:
1.Provide strategic leadership for all managed care contracting, payer relations, reimbursement strategy, and network development activities across the hospital system.
2.Develop and assist in executing managed care agreements with commercial insurers, Medicare Advantage organizations, Medicaid managed care organizations, employer groups, and other third-party payers.
3.Lead analysis for contract negotiations including reimbursement methodologies, payment models, value-based arrangements, quality incentives, risk-sharing agreements, and contract renewals.
4.Evaluate payer performance, reimbursement trends, denials, contract compliance, and financial outcomes to identify opportunities for revenue optimization and operational improvement.
5.Serve as a liaison with health plans, accountable care organizations, employer groups, physician organizations, brokers, and strategic business partners.
6.Monitor federal and state healthcare regulations, reimbursement policies, and industry trends to ensure organizational compliance and proactively respond to market changes.
7.Provide leadership and oversight for contract implementation, operational readiness, and communication of contractual requirements to affected departments.
8.Assist in developing policies, procedures, and internal controls supporting managed care operations and contract compliance.
9.Establish departmental goals, performance metrics, and strategic priorities aligned with the hospital system's mission and long-term objectives.
10.Recruit, mentor, develop, and evaluate managed care personnel while fostering a culture of accountability, collaboration, and continuous improvement.
Education and Experience
• Bachelor's Degree in Healthcare Administration, Business Administration, Finance, Public Health, or a related field from an accredited college or university.
• Master's Degree in Healthcare Administration (MHA), Business Administration (MBA), Finance, Public Health, or related discipline preferred.
• Minimum of five (5) to ten (10) years of progressively responsible experience in managed care contracting, payer relations, healthcare finance, or healthcare administration preferred.
• Minimum of five (5) years of leadership experience directing managed care, contracting, reimbursement, or healthcare operations.
• Experience negotiating complex hospital and health system payer agreements, including value-based reimbursement models, preferred.
• Experience working with integrated delivery systems, physician networks, accountable care organizations, or multi-hospital systems preferred.
Required Licensures/Certifications/Registrations
• None required.
• Certified Healthcare Financial Professional (CHFP), Certified Professional in Healthcare Quality (CPHQ), Fellow of the American College of Healthcare Executives (FACHE), or similar certification preferred.
Knowledge, Skills, and Abilities
• Extensive knowledge of managed care contracting, reimbursement methodologies, hospital finance, and revenue cycle operations.
• Comprehensive understanding of Medicare, Medicaid, Medicare Advantage, commercial insurance, and value-based payment models.
• Advanced financial analysis and contract modeling skills.
• Strong negotiation and relationship management abilities.
• Thorough knowledge of healthcare regulations, compliance requirements, and contractual language.
• Demonstrated strategic planning, organizational leadership, and change management experience.
• Ability to interpret complex financial, operational, and regulatory data and translate findings into strategic recommendations.
• Exceptional communication and presentation skills with the ability to interact effectively with executive leadership, physicians, Board members, and external partners.
• Strong project management, organizational, and analytical skills.
• Advanced proficiency with Microsoft Office Suite, contract management systems, revenue cycle applications, and healthcare analytics platforms.
Interaction with Other Departments and Relationships
Works collaboratively with the Executive Leadership Team, Medical Staff leadership, Finance, Revenue Cycle, Patient Access, Case Management, Compliance, Legal, Quality, Population Health, Business Development, Information Technology, Physician Practice Leadership, and Operations. Serves as a resource for commercial insurers, government payers, employer groups, brokers, consultants, and other strategic business partners.
Physical Capabilities
Position requires prolonged periods of sitting, computer use, telephone communication, and attendance at meetings. Requires the ability to occasionally lift up to 20 pounds and travel between hospital campuses, provider offices, payer meetings, and professional conferences.
Environmental/Working Conditions
Work is primarily performed in a professional office environment with occasional travel to hospital facilities, payer offices, community meetings, and industry conferences. Position may require occasional evening or weekend meetings to support organizational initiatives.
Direct Reports
• Managed Care Operations Managers
• Health Data Analyst
• Managed Care Contract Manager
• Network Development Specialist
• Enrollment Specialist
UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
*Request for accommodations in the hire process should be directed to UMC Human Resources.*