Senior Director Managed Care - Hybrid

This is a hybrid position based at our beautiful corporate office located in Brentwood, TN, with on-site work required Monday through Wednesday.

DUTIES AND 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.

QUALIFICATIONS

EDUCATION

• Bachelor’s degree in Business Administration, Healthcare Administration, Finance, or related field required; Master’s degree preferred.

EXPERIENCE

• Minimum of 7 years of negotiation experience for hospitals, ASCs with major commercial payors with 5 years of leadership experience.
• Experience working with clinically integrated networks, ACO’s, or other population health initiatives a plus, but not required.
• Experience working with payors and billing office staff to resolve payment discrepancies.

LICENSE(S)/CERTIFICATION(S)

• Certified Managed Care Executive (CMCE) or similar certification preferred.

KNOWLEDGE/SKILLS/ABILITIES

• 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.

CORE COMPETENCIES

• Strategic thinking, negotiation, financial acumen, relationship management, problem-solving, and team leadership.

WORKING CONDITIONS

PHYSICAL REQUIREMENTS

• Physical Requirements Occasionally 0 – 33% Frequently 34 – 66% Constant 67 – 100%
• Talk / Hear X
• See X
• Sit X
• Repetitive Use of Hands X

Hazards and Atmospheric Conditions