Director of Managed Care Contracting

Director Of Managed Care Contracting

The Director of Managed Care Contracting is responsible for leading the strategic planning, financial analysis, negotiation, and execution of new and renewed managed care agreements across an assigned hospital portfolio. This role serves as a key corporate liaison, partnering closely with Operations, Business Development, and cross-functional corporate teams to ensure alignment and support throughout the contracting lifecycle.

The primary focus of this position is to drive net revenue growth through the development of favorable contracts that exceed the cost of care delivery. Additionally, the Director will work to maximize referral volume from each executed agreement and identify opportunities to expand out-of-network volume where appropriate.

This role also plays a critical leadership function in the integration of newly acquired hospitals and in managing contracting implications related to hospital consolidations and closures.

Responsibilities

Analyze, negotiate, and implement new and renegotiated contracts for assigned hospital portfolio. Develop payor strategies to ensure optimal contracting and operational performance for hospitals.

• Responsible for rate and payment methodologies, contract language, as well as following all internal controls for contract review and administration, approval, and signature.
• Manage implementation of new contracts / renegotiations / physician agreements.
• Manage and act as corporate liaison for assigned regional and national contracts.
• Oversee credentialing / re-credentialing and billing / reimbursement development.
• Ensure COLA's are administered in accordance to contract terms.
• Complete and execute Single Case Agreements.

Liaison between DBD's, CEO's, CBO, and Payor Provider Relations staff, to assure that the requirements of a contract can be implemented and maintained.

Lead role for key payor meetings and issues / resolution tracking.

Coordinate information and analysis requests from corporate case management.

Business Development and Integration.

Qualifications