FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Regional Director of Managed Care, Payor Relations
PAM Health. Ensure PAM Health and key facilities participate in important managed care plan networks .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managed care contracting, including negotiation of agreements and rates, while maintaining compliance with reimbursement standards and regulations. Possesses strong analytical skills to evaluate payor contract data and identify opportunities for revenue growth.
Highest-signal resume keywords
Managed Care ContractingNegotiation SkillsData AnalysisManaged Care CertificationsEffective Communication
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Contract NegotiationManaged Care KnowledgeFinancial Detail OrientationHealth Plan Portal ProficiencyReimbursement Standards ComplianceContract EvaluationManaged Care Strategy DevelopmentPayor Relationship ManagementContract Summary DevelopmentHealthcare Reform Awareness
Soft Skills
Effective Written CommunicationEntrepreneurial MindsetProblem-SolvingCollaborationLeadership
Tools & Technologies
Smart SheetProvider Portal
Certifications & Qualifications
Managed Care Certifications
Industry Keywords
Managed MedicareManaged MedicaidACOBundled PaymentsGain Sharing ProgramsHealth Exchange BenefitsTricareVA CCN ProgramsTransparency RegulationsProvider Directory Requirements
About the role
Key responsibilities & impact- Ensure PAM Health and key facilities participate in important managed care plan networks
- Maintain and develop relationships with targeted payor sources
- Secure, maintain, and renegotiate payor contracts to meet business and financial objectives
- Develop the payor network across Managed Medicare, Managed Medicaid, Exchange Health Plans, ACOs, Bundled Payments, and Gain Sharing Programs
- Evaluate and negotiate contracts in compliance with PAM Health requirements and reimbursement standards
- Provide contract-specific information to facilities, business offices, admissions, operations, and the Central Billing Office
- Develop, manage, and maintain payor and Smart Sheet contract summaries
- Support Voyages Behavioral Health psychiatric hospital managed care contracting, including inpatient, outpatient, and Spravato programs
- Establish and manage relationships with local, regional, and national managed care leadership
- Support development and implementation of local contracting, education, and strategic initiatives
- Support Episode of Care Management and serve as a managed care resource expert
- Resolve escalated payor payment and systemic issues with the Central Billing Office
- Collaborate with CBO leadership on escalated claim issues and requested contracts
- Report managed care opportunities and threats, provide analytics and recommendations, and share competitive transparency information
- Identify districts needing contracts and secure agreements that maintain or increase utilization
- Coordinate with Regional Operations to increase Managed Care admissions on preferred compensation terms
- Support escalated insurance payor issues and trends to reduce days sales outstanding
- Participate in and develop a disciplined contracting process
- Oversee, manage, and negotiate assigned managed care agreements and take on new IRF and LTACH facilities
- Provide leadership within the contracting team and manage priorities, standards, and work
- Develop relationships with payor decision-makers for contracting and referral management
- Identify and solve managed care and payor contract or strategy problems using data
- Explain managed care, product, contract, portal, policy, billing, and payor strategy topics to internal stakeholders
- Support Letter of Agreement processes and negotiate rates
- Review contracts, complete Contract Summaries, and secure rate increases when warranted
- Resolve non-standard managed care, payor, and billing requests
- Advise on Health Exchange benefits and updates, Provider Portal issues, Tricare, and VA CCN programs
- Facilitate Health Plan contacts to support CBO collection efforts
- Stay current on transparency regulations and Provider Directory requirements
- Expand contracting with major health plan lines of business and additional PAM Health facilities
- Identify and distribute Managed Care Scorecards and advise facilities on improvement opportunities
- Perform other business-related duties as assigned
Requirements
What you’ll need- College Degree Preferred
- 5 years Plus experience in either a Network Role within a Managed Care Health Plan or Public Payor Program, or Provider Experience in Managed Care Contracting Role
- Managed Care Certifications a plus
- Attention to financial details
- Effective written communications
- Effective communication skills
- Entrepreneurial mindset to grow organizational revenues and identify opportunities that increase margins
- Knowledge of managed care, product information, contract requirements, Health Plan Portals, policy requirements impacting billing and operations, and payor strategy
- Ability to negotiate managed care agreements and rates
- Ability to analyze managed care and payor contract data
- Ability to stay current on payor, reimbursement, CMS, and healthcare reform issues
Benefits
Comp & perks- Competitive pay
- Generous paid benefit time
- Excellent insurance options
- Education Advancement Program
- Professional growth opportunities
- Collaborative work environment
- We Care Program