Director of Managed Care
4 weeks ago
Director of Managed CareOverviewAs a vital leader in Otterbein's mission to enrich individual life journeys for all, the Director of Managed Care will lead the organization's 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 ResponsibilitiesLead day-to-day execution of the managed care strategy across all Otterbein locations.Serve as the organization's 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 & QualificationsBachelor's degree in Health Administration, Business, or a related field; Master's 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 visitsVision and dental insurancePaid Time off that accrues immediatelyPaid HolidaysLife insuranceRetirements Savings with a 401(k) or 403(b) with company matchAccess up to 100% of your net earned based wages daily through DailyPayEmployee sponsored fund for employees in needEmployee Assistance Program (EAP)Tuition Assistance*Some benefits are based on hours workedApply today and begin a meaningful career as a Director of Managed Care at Otterbein
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