Director of Managed Care Contracting

Job Description

Job Description

POSITION SUMMARY

The Director of Managed Care leads and oversees the operational, financial, programmatic, and employee-related activities within the Managed Care Contracting department. This position is responsible for setting and monitoring goals aligned with Beecan Health's strategic objectives while providing leadership in day-to-day operations, budgeting, and financial oversight. The VP collaborates across departments and with key stakeholders to ensure effective coordination of Managed Care Contracting activities across the organization and maintains crucial relationships with health plans and payers-relationships that are vital to Beecan Health's financial health and growth.

DUTIES AND RESPONSIBILITIES

• Initiate, develop, negotiate, and monitor contracts for Beecan Health, including contract renewals, amendments, and new agreements. Engage directly with VPs, Medical Directors, CEOs, CFOs, attorneys, and other executives to negotiate payment rates, structures, and contract terms.
• Provide senior management with detailed reports and analysis on managed care performance, including key financial and operational KPIs, to support net revenue budgeting, long-term planning, and the strategic development of hospital and clinical programs.
• Ensure the Managed Care team prioritizes resources for contract performance reporting and analysis, including monthly, periodic, and ad hoc data queries, with a focus on improving performance and financial outcomes through data-driven insights.
• Effectively communicate complex information to both technical and non-technical audiences, while building and maintaining strong relationships with key stakeholders, including health plans, ACOs, hospital systems, and provider networks.
• Oversee claims processing, appeals management, and utilization management to prevent revenue leakage and ensure timely and efficient resolution. Monitor and evaluate payer performance to meet operational efficiency standards and compliance requirements.
• Facilitate communication with providers and affiliates, ensuring key contract information regarding operational terms, legal requirements, and rates is shared effectively with operational and revenue cycle teams.
• Coordinate the alignment and integration of Managed Care Contracting efforts with newly acquired organizations and new partnerships, ensuring a smooth and efficient transition that aligns with Beecan Health's strategic objectives.
• Establish and manage annual financial goals, utilizing benchmarking for target setting and financial forecasting. Oversee FTEs, staffing, and operational budgets, ensuring alignment between financial targets and program priorities.
• Develop and manage annual operating and capital budgets, ensuring fiscal responsibility and meeting budget targets. Create business plans, justify variances, and analyze cost-benefit aspects of programs.
• Guide managers in resource allocation based on patient volume, space availability, budget constraints, and program priorities. Communicate the budget and its context to staff.
• Perform other related duties as required, including leading efforts to stay informed on changes to regulatory requirements that may impact managed care contracting and healthcare operations, ensuring timely adjustments to strategies and compliance.

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. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

KNOWLEDGE, SKILLS, ABILITIES & QUALIFICATIONS

The knowledge, skills, abilities described in this job description are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the essential functions of the job.