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Director of Managed Care

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Work Location:Remote with onsite as needed

Work Hours: Full time, business hours

The Director, Managed Care is a senior strategic and operational leader responsible for shaping and executing the organization's managed care strategy across a diversified portfolio of brands and partnership structures, including joint ventures (JVs), wholly owned sites, and Solis managed sites.

Reporting to the Vice President, Managed Care & Revenue Cycle, the Director leads payer negotiations, oversees market intelligence on payer activity in existing and prospective geographies, partners with business development to inform expansion strategy, and serves as the enterprise managed care subject matter expert (SME) supporting operations and the broader business.

Department Highlights:

• Highly engaged culture.
• Collaborative team environment
• Fast-paced and Growth-Oriented

Here is what you will need:

• Required:
• Bachelor's degree in business, healthcare administration, finance, or related discipline.
• 8+ years of progressive managed care experience, including direct ownership of payer negotiations.
• Demonstrated track record leading commercial and Medicare Advantage negotiations with major national and regional payers (e.g., UnitedHealthcare, Aetna, Cigna, BCBS plans, Humana, Centene).
• Deep working knowledge of reimbursement methodologies, contract language, payer policy, and the regulatory environment.
• Strong analytical and financial modeling capability; comfort building and interrogating rate impact, payer mix, and contract performance models.
• Demonstrated experience operationalizing executed agreements across revenue cycle, credentialing, and operations.
• Strong executive communication skills with the ability to present to C-suite leadership, JV boards, and external payer executives.
• Preferred:
• Master's degree (MBA, MHA, MPH).
• Prior experience in outpatient, ambulatory, or multi-site healthcare delivery (e.g., imaging, ASC, oncology, women's health, physician practices, dialysis).
• Experience operating within JV governance structures, multi-brand portfolios, and management services / managed sites arrangements.
• Familiarity with payer analytics platforms, claims data, and underpayment recovery workflows.
• Experience with value-based care, risk-based contracting, and/or direct-to-employer arrangements.
• Established network of payer relationships across markets of strategic interest.

A Day in the Life of a Director ofManaged Care:

• Strategy & Market Intelligence
• Develop and maintain the multi-year managed care strategy across all brands and partnership structures, aligned with enterprise growth, financial, and operational objectives.
• Track payer activity - including network movements, M&A, product launches (Commercial HMO/PPO/EPO, Medicare Advantage, Medicaid Managed Care, Exchange, narrow network), benefit design changes, and policy updates - in markets where the organization operates and in target expansion markets.
• Maintain competitive intelligence on peer providers' network status, contracting posture, and pricing positioning across priority geographies.
• Translate market intelligence into prioritized actions, including payer targeting, contract restructuring, product participation decisions, and rate strategy.
• Payer Negotiations - Offense & Defense
• Lead end-to-end negotiations across commercial, Medicare Advantage, Medicaid managed care, and direct-to-employer arrangements.
• Build analytically rigorous negotiation positions, including rate proposals, language redlines, fee schedule analyses, and value-based care frameworks where appropriate.
• Own the renewal and rate escalator calendar; proactively engage payers ahead of evergreen dates, anniversary windows, and termination triggers.
• Defend existing economics through ongoing payer performance monitoring, denial trend escalation, underpayment recovery oversight, and timely amendment management.
• Partner with Legal and Compliance on contract language, regulatory updates, and dispute resolution.
• Business Development Partnership
• Serve as the managed care lens for business development, providing payer landscape assessments, network adequacy analyses, and contracting feasibility input on de novo, acquisition, JV, and management services opportunities.
• Recommend market entry sequencing and partnership structures based on payer dynamics and projected contracting outcomes.
• Provide pro forma inputs on expected payer mix, anticipated contracted rates, and ramp assumptions.
• Proactively flag areas of need and interest based on payer environment, network gaps, and emerging opportunity zones.
• Operations Support & Subject Matter Expertise
• Operationalize newly executed agreements in partnership with revenue cycle, credentialing, IT, finance, and site operations - ensuring rates are loaded correctly, fee schedules are configured, payer-specific workflows are documented, and go-live readiness is achieved.
• Serve as enterprise SME on payer policies, prior authorization requirements, medical policy changes, and reimbursement methodologies (fee-for-service, case rate, bundled, capitation, value-based).
• Educate and equip operations leaders on contract terms, payer requirements, and reimbursement nuances relevant to their day-to-day execution.
• Troubleshoot payment variances, underpayment trends, and contract interpretation disputes alongside revenue cycle leadership.
• Portfolio & Partnership Management
• Calibrate the level of managed care involvement and decision rights by brand and partnership structure:
• Wholly owned sites: Full ownership of strategy, negotiation, and execution.
• Joint Ventures: Collaborative governance with JV partners; includes managed care committee participation, JV board-level reporting, and partner-aligned decision-making.
• Managed sites: Advisory and contracted-services posture with clear scope, deliverables, and service-level expectations.
• Establish and maintain clear engagement models, escalation paths, and reporting cadences with each partner and brand.
• Leadership & Cross-Functional Engagement
• Build and lead a high-performing managed care team (analysts and contract managers) as the portfolio scales.
• Represent managed care in cross-functional forums including finance, operations, business development, legal, clinical leadership, and partner-facing committees.
• Develop and deliver executive-level reporting on contract status, payer performance, market activity, and strategic initiatives.

Why Solis Mammography?

• A Great Place to Work, earning this prestigious award for multiple years running.
• Offer competitive benefits such as Medical, Dental, Vision, 401k, PTO, Paid Holidays, Backup Child/Adult Care as well as other unique benefits.

At Solis Mammography, we save lives. We shape the future of women's health. We are empowered, appreciated, and part of something bigger. Together, we deliver compassionate, exceptional care. Every patient. Every time.

Our patient-focused culture is at the heart of every interaction. We deliver the care, compassion and high-touch experience that have made us a valued healthcare partner to the generations of women that we serve. As the nation's leader in breast health services, our commitment to providing excellence in patient care is realized at every level of our organization.