Director, Managed Care

Fulcrum Health Partners; Nashville (TN); Hybrid; USD 140,000 - 160,000; Full time

Job summary

Fulcrum Health Partners in Nashville is seeking a Director of Payer Negotiations to lead end-to-end rate negotiations for hospitals, physician groups, and multi-site providers. You will set strategy, benchmark against market data, and own client relationships, reporting directly to the CEO.

You will build and mentor a team, develop payer-by-payer strategies, and deliver proposals that move rates and language with both commercial and government payers.

Qualifications

• 5–8 years of managed care experience with direct, hands-on participation in payer contract negotiations.
• Demonstrated track record of moving rates and contract language with commercial and government payers.
• Deep command of reimbursement methodologies across fee-for-service, case rate, per diem, capitation, bundled, and value-based arrangements.
• Strong financial modeling judgment — able to direct, review, and defend the analysis behind a rate position.
• Experience serving as a primary point of contact for client, executive, or senior internal stakeholders.
• Experience mentoring analysts or associates and reviewing their work product.
• Executive-level written and verbal communication and presence with C-suite audiences.

Responsibilities

• Lead payer negotiations end to end for hospitals and provider groups.
• Develop payer-by-payer strategy, rate positioning, and walk-away analysis grounded in market benchmarks and client leverage.
• Prepare and deliver rate proposals, counter-proposals, and language positions, driving negotiations to signed agreements.
• Direct the financial modeling behind every rate position and defend it under payer challenge.
• Serve as the senior point of contact and trusted advisor to client C-suite, finance, and managed care leadership.
• Translate complex reimbursement analysis into clear strategic recommendations for executives and boards.
• Own engagement outcomes — scope, economics, quality, and the results reported back to the client.
• Convert delivered results into repeat and referral work.

Skills

Payer negotiations

Managed care

Negotiation strategy

Financial modeling

Executive communication

Education

Bachelor's degree in business, finance, healthcare administration, or related field

Job description

Fulcrum Health Partners | Nashville, TN (Hybrid — 2-3 days onsite) | Full-Time | Reports to the CEO

Today's Challenges. Tomorrow's Solutions.

Experience: 5–8 years in managed care with hands‑on payer negotiation experience.

Compensation: $140,000 – $160,000 per year, plus performance bonus.

ABOUT FULCRUM HEALTH PARTNERS

Fulcrum Health Partners is an advisory firm working at the intersection of provider reimbursement, payer contracting, and healthcare M&A — trusted by health systems, physician groups, and deal‑side clients alike. A fulcrum is where a small, well‑placed force moves a very large weight; that is our work — applying the right leverage at the right point in the system. We are growing quickly, and we are building the senior bench that lets us take on more clients and more complex negotiations without losing the precision our clients count on.

ABOUT THE ROLE

The Director leads payer negotiations end to end on behalf of our clients — setting strategy, sitting across the table from national and regional payers, and moving rates and language that materially change client economics. This is a hands‑on leadership role, not an oversight seat. You build the strategy, execute the negotiation, own the client relationship, and develop the team that supports it. You will report directly to the CEO and have a real hand in shaping the practice.

WHO WE'RE LOOKING FOR

You have personally negotiated with payers and you have the results to show for it. You know what moves a rate and what is just noise, you can defend your numbers when a payer pushes back, and you are credible in front of a hospital CFO. You want the ownership that comes with a named practice and a direct line to the CEO — and you would rather build something than inherit it.

WHAT YOU'LL DO

• Lead commercial, Medicare Advantage, and Medicaid negotiations end to end for hospitals, physician groups, ambulatory surgery centers, and multi‑site provider organizations.
• Develop payer‑by‑payer negotiation strategy, rate positioning, and walk‑away analysis grounded in market benchmarks, cost‑to‑collect, and each client's leverage points.
• Personally prepare and deliver rate proposals, counter‑proposals, and language positions, driving negotiations to signed agreements.
• Direct the financial modeling behind every rate position and defend it under payer challenge.
• Serve as the senior point of contact and trusted advisor to client C‑suite, finance, and managed care leadership.
• Translate complex reimbursement analysis into clear strategic recommendations for executives and boards.
• Own engagement outcomes — scope, economics, quality, and the results reported back to the client.
• Convert delivered results into repeat and referral work.

Contract & Reimbursement Analysis

• Direct rate benchmarking, reimbursement modeling, and payer performance analysis across a portfolio of engagements.
• Quantify rate exposure, underpayment, and language risk, and prioritize renegotiation targets.
• Interpret reimbursement methodologies across fee‑for‑service, value‑based, capitated, bundled, and case‑rate arrangements.
• Manage, mentor, and develop Associates and Senior Analysts; review work product and elevate analytical and negotiation capability.
• Set standards for modeling rigor, documentation, and client‑deliverable quality.
• Contribute to the methodology, tools, and standards of the firm's managed care practice.
• Support business development through scoping, proposals, and client presentations.

WHAT YOU'LL BRING (REQUIRED)

• 5–8 years of managed care experience with direct, hands‑on participation in payer contract negotiations.
• A demonstrated track record of moving rates and contract language with commercial and government payers.
• Deep command of reimbursement methodologies across fee‑for‑service, case rate, per diem, capitation, bundled, and value‑based arrangements.
• Strong financial modeling judgment — able to direct, review, and defend the analysis behind a rate position.
• Experience serving as a primary point of contact for client, executive, or senior internal stakeholders.
• Experience mentoring analysts or associates and reviewing their work product.
• Executive‑level written and verbal communication and presence with C‑suite audiences.
• Bachelor's degree in business, finance, healthcare administration, or a related field.
• Located in or willing to relocate to the Nashville, TN area and work onsite two to three days per week.

PREFERRED

• Experience at a healthcare consulting or advisory firm.
• Payer‑side network or contracting experience at a health plan.
• Hospital or health system managed care leadership experience.
• Exposure to healthcare M&A, transaction advisory, or diligence work.

COMPENSATION & BENEFITS

$140,000 – $160,000 per year, plus a performance-based bonus. [Benefits summary to be added — e.g., health/dental/vision, PTO, and retirement.]

LOCATION & TRAVEL

This is a hybrid position based in Nashville, Tennessee, with two to three days per week onsite and the balance worked remotely. Candidates must be authorized to work in the United States. Client travel — estimated at up to 25 percent — is required for payer negotiations, client meetings, team offsites, and industry events.

Fulcrum Health Partners is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, genetic information, marital status, pregnancy, or any other characteristic protected by applicable federal, state, or local law, and we provide reasonable accommodations to qualified individuals with disabilities throughout the hiring process. To request an accommodation, contact [e-mail].