Senior Director Managed Care - Hybrid

Surgery Partners, Inc•Brentwood, TN

8d•Hybrid

About The Position

This is a hybrid position based at our beautiful corporate office located in Brentwood, TN, with on-site work required Monday through Wednesday. The Senior Director Managed Care will lead contract negotiations and actively manage payer agreements for assigned hospitals, ASCs, and physician groups. This role involves partnering with leadership to develop and execute payer contracting strategies, establish and manage annual contract rate increase budgets, and conduct due diligence for acquisitions. The position requires analyzing reimbursement models, collaborating with various teams to identify discrepancies, and monitoring post-implementation contract performance. Building and maintaining relationships with payer representatives and internal stakeholders is crucial, as is communicating negotiation strategies and market conditions to leadership. The role also supports reimbursement optimization initiatives, maintains contract documentation, and participates in managed care projects and educational efforts related to payer trends and value-based care.

Requirements

Bachelor’s degree in Business Administration, Healthcare Administration, Finance, or related field required
Minimum of 7 years of negotiation experience for hospitals, ASCs with major commercial payors
5 years of leadership experience
Experience working with payors and billing office staff to resolve payment discrepancies
Extensive knowledge of managed care principles, contract negotiation, healthcare reimbursement methodologies, and regulatory requirements.
Strong analytical, communication, and leadership skills.
Excellent quantitative and analytical skills, with attention to detail to ensure that modeling for negotiations is accurate.
Moderate knowledge of Excel.
Solid understanding of payer contract reimbursement methodologies and application of payor policies on reimbursement expected under existing and future agreements.
Strong writing skills and ability to communicate effectively in order to negotiate key terms for payor agreements.
Strong understanding of healthcare industry trends in payor negotiations including contract language, product development trends, pay for performance programs, bundled payment programs, etc.
Solid understanding of billing methodologies by ASCs/hospitals. Ability to review a hospital or ASC claim and determine if the payor reimbursed the claim accurately or not as a result of how it was billed.
Strategic thinking, negotiation, financial acumen, relationship management, problem-solving, and team leadership.

Nice To Haves

Master’s degree preferred.
Experience working with clinically integrated networks, ACO’s, or other population health initiatives a plus, but not required.
Certified Managed Care Executive (CMCE) or similar certification preferred.

Responsibilities

Lead contract negotiations and actively manage payer agreements for assigned hospitals, ASCs, and physician groups, including commercial, Medicare Advantage, Medicaid managed care, workers’ compensation, exchange, and self-funded employer plans.
Partner with facility, physician group, and operational leadership to develop and execute payer contracting strategies aligned with organizational growth, reimbursement, and financial objectives.
Establish and manage annual contract rate increase budgets and reimbursement goals for assigned facilities, maintaining accountability for achieving or exceeding financial targets.
Conduct due diligence for acquisitions by reviewing payer contracts, reimbursement structures, claims payment accuracy, and market opportunities for contract improvement.
Analyze reimbursement models, contract proposals, payment methodologies, and financial scenarios to support negotiation strategy and evaluate revenue impact.
Collaborate with analysts, revenue cycle, and business office teams to identify reimbursement discrepancies, underpayments, overpayments, and contract compliance issues.
Monitor post-implementation contract performance to validate reimbursement outcomes, identify variances from modeled expectations, and address payer compliance concerns.
Build and maintain effective relationships with payer representatives, provider relations teams, senior negotiators, and internal stakeholders across operations, finance, and physician leadership.
Communicate negotiation strategies, contract renewals, market conditions, and key payer initiatives to executive and operational leadership through regular updates and presentations.
Support reimbursement optimization initiatives, including charge strategy recommendations, chargemaster updates, contract amendments, and implementation of automatic rate escalators.
Maintain contract documentation, summaries, and repositories while ensuring accurate contract interpretation, operational handoff, and system documentation.
Participate in managed care projects, reimbursement initiatives, market research, legislative support activities, and educational efforts related to payer trends, market changes, and value-based care.