Director Managed Care

About the role

Under the general supervision of the CFO, the Managed Care Director will provide strategic leadership and expert oversight for all aspects of MCW's payer relations and contracting, ensuring optimal financial performance and sustainable partnerships with health plans. The Director will develop and implement new and established contracts for professional services on behalf of the MCW Medical College Physicians adult specialty care practice. This role will lead negotiations with payers to include payment terms based on multiple reimbursement models, including fee-for-service payment terms, value-based payments, and gain/risk sharing agreements. The Director will be responsible for negotiating contract language that aligns with all State and Federal laws and regulations, and organizational policies. This position will collaborate closely with ACO/CIN partners to ensure compliant and equitable reimbursement under value-based care contracts and programs. Hybrid role: Primarily remote with occasional onsite presence. Primary Responsibilities Manage relationships with payers, lead negotiations, preparation, documentation, and implementation of new and established managed care contracts for professional services on behalf of the MCW Medical College Physicians adult specialty care practice. Develop standards for contracts, including payment terms, general language and provisions based on strategy discussions, senior management input, and organizational needs. Evaluate rate proposals, changes to reimbursement methodologies, and conduct related analyses to ensure continued financial viability of the contract. In collaboration with MCW and MCP Senior Leadership, develop and execute communication plans and payer negotiation outlines related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace. Stays current with emerging payer trends, new reimbursement methodologies, state specific regulatory issues, plan benefits, payer activity, products, and delivery channels, including health insurance exchanges, market competition, etc. Ensure contracts and proposals are properly entered into organizational database to measure, track, and monitor utilization and financial performance of managed care contracts. Negotiate single case agreements to capture financial reimbursement from non-contracted payers and entities. Serves as primary organizational contact during payer contract negotiations. Assists CPS and internal customers with resolution of complex payer issues. Participate in JOC and leadership meetings with third party payers to address contractual payment issues and trends. Communicates and provides tools for contractual terms to other departments whose functions are necessary to the development, implementation, and management of the provider arrangements. Knowledge - Skills - Abilities Possess strong analytical and negotiation skills Comprehensive understanding of healthcare reimbursement methodologies, managed care models, and regulatory requirements. Proven leadership experience in payer contracting and relations within a complex healthcare environment. Advanced proficiency in Microsoft Office products; ability to create and interpret complex reports and data sets. Strong analytical and problem-solving skills, with the ability to identify trends, investigate issues, and develop actionable solutions. Excellent written and verbal communication skills, including the ability to present complex information clearly to diverse audiences. Effective interpersonal and listening skills, with a professional and confident demeanor in interactions with physicians, staff, and leadership. Ability to manage multiple tasks and priorities simultaneously, demonstrating flexibility and adaptability in a dynamic healthcare environment. Ability to provide education and training to physicians, department administrators, and health system leaders on payer contracting and reimbursement strategies. Attention to detail and accuracy, especially in reviewing financial data and managed care contracts. Patience and diplomacy in resolving sensitive or complex issues across departments and with external stakeholders. Capacity to lead and participate in improvement initiatives, policy development, and special projects related to reimbursement and payer contracting.