Director of Managed Care Contracting

Beecan Health - CA•Glendale, CA

50d

About The Position

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.

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. Certifications such as CMCP or other relevant professional certifications are a plus.
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.
Professional knowledge of facility licensing (CDPH), complaint investigation and validation surveys (CMS), Joint Commission accreditation and certifications, and Managed Care Medi-Cal certifications (DHCS).
Familiarity with evolving healthcare legislation and compliance requirements is a plus.
Strong understanding of facility quality guidelines, compliance, and policy development.
Proven ability to work collaboratively with senior management, providers, and staff.
Working knowledge of laws and regulations governing nursing facilities and principles of nursing home administration.
Commitment to the Beecan mission to consistently deliver high quality, person-centered care with dignity, respect, compassion, and integrity, and to enrich every life we touch. Embracing Beecan values of care & compassion, community, honesty & integrity, teamwork, innovation, and safety.
Ability to represent the Company and interact with others in an ethical and professional manner, and to maintain accountability.
Must have excellent time management skills with a proven ability to prioritize and meet deadlines.
Must have strong analytical and creative problem-solving skills.
Must demonstrate flexibility and ability to adapt to change.
Ability to maintain confidentiality, and to exercise discretion and independent judgment to make logical, practical decisions.
Ability to understand and follow applicable regulations, policies, and procedures fully and consistently.
Ability to inspire trust and respect and mobilize others, and the ability to motivate staff to achieve desired results.
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.

Nice To Haves

Master's degree in a relevant subject preferred. Certifications such as CMCP or other relevant professional certifications are a plus.
Familiarity with evolving healthcare legislation and compliance requirements is a plus.

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.