Director of Managed Care
Director of Managed Care
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
As a vital leader in Otterbeins mission to enrich individual life journeys for all the Director of Managed Care will lead the organizations managed care strategy across post-acute and skilled nursing settings. This position serves as the internal and external expert on managed care contracts payer relations and value-based care initiatives. In collaboration with clinical operational and financial teams the Director will drive financial performance improve payer relationships and implement processes to enhance managed care outcomes and revenue integrity.
Primary Duties and Responsibilities
- Lead day-to-day execution of the managed care strategy across all Otterbein locations.
- Serve as the organizations expert and primary contact for all managed care-related matters.
- Partner with local leaders to educate and guide on payer contracts expectations and authorizations.
- Participate in and support the appeal and denial management process.
- Act as the primary liaison to external entities including OASN and Kairos Health Systems.
- Negotiate and manage payer contracts to ensure favorable terms and performance metrics.
- Develop and maintain a reporting structure for managed care income and expense by payer.
- Deliver regular analysis and actionable recommendations to senior leadership.
- Build and maintain a comprehensive managed care contract library segmented by payer location and line of business.
- Standardize and automate managed care-related processes across the organization.
- Collaborate with IT and finance to build an automated dashboard integrating key metrics (e.g. carve-outs denials LOS).
- Partner with Marketing and Operations to identify and remove admission barriers related to payer contracts.
- Assist in preparing and executing Value-Based Purchasing and Quality-related measures.
- Analyze organizational needs to determine the most effective case management model (centralized vs. decentralized).
Experience & Qualifications
- Bachelors degree in Health Administration Business or a related field; Masters degree preferred.
- Minimum 57 years of experience in managed care contracting preferably in post-acute or skilled nursing settings.
- Strong understanding of CMS regulations SNF reimbursement and the 5-Star Quality Rating System.
- Demonstrated success in managed care strategy contract negotiation and relationship management.
- Proficiency in payer financial analysis revenue cycle impact and cost structure modeling.
- Experience in building automated reporting tools/dashboards; familiarity with tools like Power BI is a plus.
BENEFITS*
- Medical insurance with free virtual doctor visits
- Vision and dental insurance
- Paid Time off that accrues immediately
- Paid Holidays
- Life insurance
- Retirements Savings with a 401(k) or 403(b) with company match
- Access up to 100% of your net earned based wages daily through DailyPay
- Employee sponsored fund for employees in need
- Employee Assistance Program (EAP)
- Tuition Assistance
*Some benefits are based on hours worked
Apply today and begin a meaningful career as a Director of Managed Care at Otterbein!
Required Experience:
Director
Employment Type
Full Time
