Director of Managed Care - FT

UMC Health System • Richmond, KY

2d • Hybrid

About The Position

The Director of Managed Care is responsible for providing strategic leadership and oversight of the hospital system's managed care operations, payer contracting, reimbursement strategies, and provider network relationships. This position develops and executes contracting strategies that maximize reimbursement, improve financial performance, expand market access, and support organizational growth. The Director serves as the primary executive liaison with commercial, government, and employer-sponsored health plans while ensuring compliance with contractual, regulatory, and accreditation requirements. The Director collaborates closely with Chief Business Development Officer and executive leadership to develop value-based care initiatives, optimize contract performance, and support the organization's strategic objectives.

Requirements

• Bachelor's Degree in Healthcare Administration, Business Administration, Finance, Public Health, or a related field from an accredited college or university.
• Minimum of five (5) years of leadership experience directing managed care, contracting, reimbursement, or healthcare operations.
• Extensive knowledge of managed care contracting, reimbursement methodologies, hospital finance, and revenue cycle operations.
• Comprehensive understanding of Medicare, Medicaid, Medicare Advantage, commercial insurance, and value-based payment models.
• Advanced financial analysis and contract modeling skills.
• Strong negotiation and relationship management abilities.
• Thorough knowledge of healthcare regulations, compliance requirements, and contractual language.
• Demonstrated strategic planning, organizational leadership, and change management experience.
• Ability to interpret complex financial, operational, and regulatory data and translate findings into strategic recommendations.
• Exceptional communication and presentation skills with the ability to interact effectively with executive leadership, physicians, Board members, and external partners.
• Strong project management, organizational, and analytical skills.
• Advanced proficiency with Microsoft Office Suite, contract management systems, revenue cycle applications, and healthcare analytics platforms.

Nice To Haves

• Master's Degree in Healthcare Administration (MHA), Business Administration (MBA), Finance, Public Health, or related discipline preferred.
• Minimum of five (5) to ten (10) years of progressively responsible experience in managed care contracting, payer relations, healthcare finance, or healthcare administration preferred.
• Experience negotiating complex hospital and health system payer agreements, including value-based reimbursement models, preferred.
• Experience working with integrated delivery systems, physician networks, accountable care organizations, or multi-hospital systems preferred.
• Certified Healthcare Financial Professional (CHFP), Certified Professional in Healthcare Quality (CPHQ), Fellow of the American College of Healthcare Executives (FACHE), or similar certification preferred.

Responsibilities

• Provide strategic leadership for all managed care contracting, payer relations, reimbursement strategy, and network development activities across the hospital system.
• Develop and assist in executing managed care agreements with commercial insurers, Medicare Advantage organizations, Medicaid managed care organizations, employer groups, and other third-party payers.
• Lead analysis for contract negotiations including reimbursement methodologies, payment models, value-based arrangements, quality incentives, risk-sharing agreements, and contract renewals.
• Evaluate payer performance, reimbursement trends, denials, contract compliance, and financial outcomes to identify opportunities for revenue optimization and operational improvement.
• Serve as a liaison with health plans, accountable care organizations, employer groups, physician organizations, brokers, and strategic business partners.
• Monitor federal and state healthcare regulations, reimbursement policies, and industry trends to ensure organizational compliance and proactively respond to market changes.
• Provide leadership and oversight for contract implementation, operational readiness, and communication of contractual requirements to affected departments.
• Assist in developing policies, procedures, and internal controls supporting managed care operations and contract compliance.
• Establish departmental goals, performance metrics, and strategic priorities aligned with the hospital system’s mission and long-term objectives.
• Recruit, mentor, develop, and evaluate managed care personnel while fostering a culture of accountability, collaboration, and continuous improvement.

Benefits

• Equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

What This Job Offers

• Job Type: Full-time
• Career Level: Director