Local Infusion
Director, Managed Care Contracting
Local Infusion, Nashville, Tennessee, United States, 37247
Director, Managed Care Contracting
We are seeking a Director of Managed Care that leads and oversees the operational, financial, programmatic, and employee‑related activities within the Managed Care Contracting department. This new role will develop the vision and execution of a payer strategy, reporting to the SVP of Enterprise Growth and Strategy to build out the function to support rapid growth.
Responsibilities
Initiate, develop, negotiate, and monitor contracts, including renewals, amendments, and new agreements, engaging with finance, field leaders, and stakeholders to negotiate payment rates, structures, and contract terms.
Facilitate executive‑level relationships with health plan partners and communicate value creation by Local Infusion.
Provide senior management with detailed reports and analysis on managed care performance, including key financial and operational KPIs, supporting net revenue budgeting and long‑term planning.
Ensure the team prioritizes contract performance reporting and analysis, focusing on improving performance and financial outcomes through data‑driven insights.
Effectively communicate complex information to both technical and non‑technical audiences, building and maintaining strong relationships with health plans, ACOs, hospital systems, and provider networks.
Oversee claims processing, appeals management, and utilization management to prevent revenue leakage and ensure timely resolution.
Facilitate communication with providers and affiliates about contract operational terms, legal requirements, and rates.
Coordinate alignment and integration of contracting efforts with newly acquired organizations and new partnerships.
Establish and manage annual financial goals, using benchmarking for target setting and forecasting; oversee staffing and operational budgets.
Develop and manage operation and capital budgets, ensuring fiscal responsibility and meeting budget targets.
Guide managers in resource allocation based on patient volume, budget constraints, and program priorities.
Perform related duties, including staying informed on regulatory changes that may impact managed care and operations, ensuring timely strategic adjustments.
The above listing of duties and responsibilities are not intended to be all‑inclusive but rather to serve as a description of the range of duties and general nature of the position.
Qualifications
Bachelor’s degree in a relevant subject area such as Accounting, Business Administration, Finance, or Health Care required; Master’s preferred.
Minimum of 10 years of experience in managed care contracting or provider network management, with a proven track record in an insurance or healthcare setting.
Experience in a large academic or complex health program with managed care expertise.
Proven leadership experience in managed care contracting or a related field, focusing on transformational leadership, cross‑functional collaboration, and strategic outcomes.
Proven experience negotiating contracts with Medicare Advantage plans, Medicaid Managed Care, and commercial payers, ensuring favorable reimbursement rates and risk‑sharing models.
Ability to develop and optimize reimbursement strategies, including risk‑sharing models and value‑based payment structures.
Experience working with C‑Suite executives in a complex healthcare setting.
Ability to convey complex technical information clearly to technical and non‑technical audiences.
Analytical skills: identify issues, analyze data, recommend and implement solutions.
Strong initiative, decision‑making, and problem‑solving skills.
Familiarity with evolving healthcare legislation and compliance requirements.
Strong understanding of facility quality guidelines, compliance, and policy development.
Collaborative ability to work with senior management, providers, and staff.
Seniority level:
Director Employment type:
Full‑time Job function:
Health Care Provider
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Responsibilities
Initiate, develop, negotiate, and monitor contracts, including renewals, amendments, and new agreements, engaging with finance, field leaders, and stakeholders to negotiate payment rates, structures, and contract terms.
Facilitate executive‑level relationships with health plan partners and communicate value creation by Local Infusion.
Provide senior management with detailed reports and analysis on managed care performance, including key financial and operational KPIs, supporting net revenue budgeting and long‑term planning.
Ensure the team prioritizes contract performance reporting and analysis, focusing on improving performance and financial outcomes through data‑driven insights.
Effectively communicate complex information to both technical and non‑technical audiences, building and maintaining strong relationships with health plans, ACOs, hospital systems, and provider networks.
Oversee claims processing, appeals management, and utilization management to prevent revenue leakage and ensure timely resolution.
Facilitate communication with providers and affiliates about contract operational terms, legal requirements, and rates.
Coordinate alignment and integration of contracting efforts with newly acquired organizations and new partnerships.
Establish and manage annual financial goals, using benchmarking for target setting and forecasting; oversee staffing and operational budgets.
Develop and manage operation and capital budgets, ensuring fiscal responsibility and meeting budget targets.
Guide managers in resource allocation based on patient volume, budget constraints, and program priorities.
Perform related duties, including staying informed on regulatory changes that may impact managed care and operations, ensuring timely strategic adjustments.
The above listing of duties and responsibilities are not intended to be all‑inclusive but rather to serve as a description of the range of duties and general nature of the position.
Qualifications
Bachelor’s degree in a relevant subject area such as Accounting, Business Administration, Finance, or Health Care required; Master’s preferred.
Minimum of 10 years of experience in managed care contracting or provider network management, with a proven track record in an insurance or healthcare setting.
Experience in a large academic or complex health program with managed care expertise.
Proven leadership experience in managed care contracting or a related field, focusing on transformational leadership, cross‑functional collaboration, and strategic outcomes.
Proven experience negotiating contracts with Medicare Advantage plans, Medicaid Managed Care, and commercial payers, ensuring favorable reimbursement rates and risk‑sharing models.
Ability to develop and optimize reimbursement strategies, including risk‑sharing models and value‑based payment structures.
Experience working with C‑Suite executives in a complex healthcare setting.
Ability to convey complex technical information clearly to technical and non‑technical audiences.
Analytical skills: identify issues, analyze data, recommend and implement solutions.
Strong initiative, decision‑making, and problem‑solving skills.
Familiarity with evolving healthcare legislation and compliance requirements.
Strong understanding of facility quality guidelines, compliance, and policy development.
Collaborative ability to work with senior management, providers, and staff.
Seniority level:
Director Employment type:
Full‑time Job function:
Health Care Provider
#J-18808-Ljbffr