Vice President of Managed Care

The Vice President of Managed Care is responsible for developing, leading and optimizing managed care strategies. This role ensures the organization optimizes reimbursement from payers, maintains strong relationships with payers and manages related administrative issues, including payer credentialing. The Vice President of Managed Care works closely with executive leadership, clinical leadership, revenue cycle management, value-based care, and risk management to negotiate contracts, support day-to-day business operations, and drive strategic initiatives.

Primary Finance

Job Responsibilities /Tasks may include, but not limited to:

* Strategy Development: design and implement managed care strategies that support the organization's financial and clinical objectives.

* Contract Negotiation: lead negotiations with insurance companies and other third-party payers to secure beneficial reimbursement rates and terms.

* Relationship Management: build and maintain strong partnerships with payers and other stakeholders

* Monitoring: monitor industry trends and regulatory changes to inform business decisions and adapt strategies.

* Financial Oversight: work with finance and RCM teams to analyze contract performance, identify opportunities for revenue enhancement, and ensure compliance with payer contracts.

* Team Leadership:
Manage and mentor a team; foster collaboration across departments

* Compliance: ensure adherence to industry standards and federal and state healthcare regulations.

* Reporting: provide regular reports and presentations to executive leadership regarding managed care performance and initiatives.

* Other day-to-day activities as assigned by the CFO.

Position

Qualifications:

* Bachelor's or Master's degree

* Extensive experience in managed care or payer contracting, with a minimum of 10 years of progressive leadership experience.

* Strong understanding of healthcare reimbursement methodologies, payer relations, and regulatory compliance.

* Strong negotiation, analytical and communication skills.

* Proven ability to lead cross-functional teams and drive change.