Director, Managed Care Contracting

Local Infusion•Nashville, TN

27d

About The Position

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 is a new role within the organization that will help develop the vision and the execution of Payer Strategy. The Director will report to the SVP of Enterprise Growth and Strategy to build out the function in order to support rapid growth. This position is responsible for setting and monitoring goals aligned with Local Infusion's strategic objectives while providing leadership in day-to-day operations, budgeting, and financial oversight. The Director 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 Local Infusion’s financial health and growth.

Requirements

Bachelor's degree in a relevant subject area such as Accounting, Business Administration, Finance, Health Care required; Master's degree in a relevant subject preferred.
Minimum of 10 years of experience in managed care contracting or provider network management, with a proven track record of success in an insurance or healthcare setting.
Experience in a large academic or complex health program that includes Managed Care experience.
Proven leadership experience in managed care contracting or a related field, with a focus on transformational leadership, cross-functional collaboration, and driving strategic outcomes.
Proven experience negotiating contracts with Medicare Advantage plans, Medicaid Managed Care, and commercial payers, ensuring favorable reimbursement rates and risk-sharing models.
Develop and optimize reimbursement strategies, including risk-sharing models and value-based payment structures, to ensure financial sustainability and align incentives with quality patient care outcomes.
Experience working with C-Suite Executives in a complex healthcare setting.
Ability to convey complex technical information in clear and concise communications to technical and non-technical audiences.
Ability to identify issues, analyze data, develop, recommend, and implement solutions.
Possess initiative, decision-making skills and problem-solving abilities.
Strong understanding of facility quality guidelines, compliance, and policy development.
Proven ability to work collaboratively with senior management, providers, and staff.

Nice To Haves

Familiarity with evolving healthcare legislation and compliance requirements is a plus.

Responsibilities

Initiate, develop, negotiate, and monitor contracts for Local Infusion, including contract renewals, amendments, and new agreements. Engage directly with finance, field leaders, and other stakeholders to negotiate payment rates, structures, and contract terms.
Facilitate executive level relationships with health plan partners and effectively communicate value creation by Local Infusion.
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 health plan relationships.
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 Local Infusion’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.