Director - Managed Care

Mosaic Life Care; Saint Joseph (MO); On-site; USD 180,000 - 240,000; Full time

Benefits offered by this job

Concierge services

Employee lounge

Wellness programs

Free parking

On-site and virtual health clinics

Job summary

Mosaic Life Care is seeking a Director of Managed Care to lead the development, negotiation, implementation and management of payer contracts across commercial, government, and value-based models. This executive role partners with Finance, Revenue Cycle, Legal and senior leadership to optimize reimbursement, improve financial performance and support strategic aims.

The Director will oversee the Managed Care department, drive strategic plans, monitor market trends and CMS regulations, and build

Qualifications

• Bachelor's Degree in Healthcare Administration, Finance, Business, Accounting, Economics, or related field - Required Upon Hire
• MBA/MHA - Preferred
• 7-10 years of progressive healthcare finance or managed care experience - Required
• 3-5 years payer contract negotiation experience - Required
• Experience with commercial, Medicare Advantage, and Medicaid Managed Care contracting
• Experience in 340b, DSH, Sole Community Hospital, Critical Access Hospital, rural health clinics, provider-based and physician reimbursement

Responsibilities

• Provide executive leadership and strategic direction for managed care contractual relationships, including commercial, Medicare, Medicaid, and other payer arrangements.
• Develop and execute managed care strategies aligned with organizational goals.
• Negotiate payer contractual agreements, including commercial, Medicare Advantage, Medicaid Managed Care, employer, hospital, professional, ancillary, and value-based contracts.
• Review reimbursement methodologies including DRG, APC, fee schedule, per diem, percent of charges, case rates, and capitation.
• Partner with FP&A, Decision Support, and Reimbursement teams to model reimbursement, margins, and financial impact.
• Partner with Revenue Cycle to monitor payer performance, denials, underpayments, contract compliance, and other contractual opportunities that improve revenue and reduce leakage.
• Monitor market trends and CMS regulations that may affect payer strategy, reimbursement, contract compliance, and provider enrollment operations.
• Responsible for building positive relationships with key health plans through regular communications/meetings to support the organizational goals.
• Communicate managed care changes, policy updates, and strategic direction across the organization to support alignment and timely implementation.

Skills

Revenue cycle

Healthcare finance

CMS regulations

Value-based reimbursement

Financial modeling

Negotiation

Contract interpretation

Analytics

Project management

Education

Bachelor's Degree (Healthcare Administration/Finance/Business)

MBA/MHA (Preferred)

Tools

Epic

Oracle ERP/EPM

Strata

Advanced Excel

Power BI/Tableau

Job description

Job DescriptionThe Director of Managed Care is responsible for developing, negotiating, implementing, and managing commercial, governmental, and value-based payer contracts to optimize reimbursement, support organizational strategy, and improve financial performance. Reporting to the ACFO, this leader oversees the Managed Care department, partners with finance, revenue cycle, legal, and executive leadership, and develops payer strategies that enhance access, profitability, and long-term sustainability.

Job DescriptionThe Director of Managed Care is responsible for developing, negotiating, implementing, and managing commercial, governmental, and value-based payer contracts to optimize reimbursement, support organizational strategy, and improve financial performance. Reporting to the ACFO, this leader oversees the Managed Care department, partners with finance, revenue cycle, legal, and executive leadership, and develops payer strategies that enhance access, profitability, and long-term sustainability.The Director supports organizational revenue goals through effective payer relationships, contractual agreements, and operational partnership. This role requires initiative, self-direction, leadership, and a team-oriented approach, with the ability to translate information into targeted action plans that meet evolving organizational needs. The Director must build collaborative relationships with internal stakeholders and external partners, influence decision-making outside direct reporting lines, and perform other duties as assigned.Responsibilities

• Provide executive leadership and strategic direction for managed care contractual relationships, including commercial, Medicare, Medicaid, and other payer arrangements.
• Develop and execute managed care strategies aligned with organizational goals.
• Negotiate payer contractual agreements, including commercial, Medicare Advantage, Medicaid Managed Care, employer, hospital, professional, ancillary, and value-based contracts, to meet organizational goals.
• Review reimbursement methodologies including DRG, APC, fee schedule, per diem, percent of charges, case rates, and capitation.
• Partner with FP&A, Decision Support, and Reimbursement teams to model reimbursement, margins, and financial impact.
• Partner with Revenue Cycle to monitor payer performance, denials, underpayments, contract compliance, and other contractual opportunities that improve revenue and reduce leakage.
• Monitor market trends and CMS regulations that may affect payer strategy, reimbursement, contract compliance, and provider enrollment operations.
• Responsible for building positive relationships with key health plans through regular communications/meetings to support the organizational goals.
• Communicate managed care changes, policy updates, and strategic direction across the organization to support alignment and timely implementation.

Education

• Bachelor's Degree - in Healthcare Administration, Finance, Business, Accounting, Economics, or related field - Required Upon Hire
• MBA/MHA - Preferred

Work Experience

• 7-10 Years - progressive healthcare finance or managed care experience - Required
• 3-5 Years - payer contract negotiation experience - Required
• Experience with commercial, Medicare Advantage, and Medicaid Managed Care contracting
• Experience in 340b, DSH, Sole Community Hospital, Critical Access Hospital, rural health clinics, provider-based ad physician reimbursement

QualificationsKnowledge & Skills

• Revenue cycle
• Healthcare finance
• CMS regulations
• Value-based reimbursement
• Financial modeling
• Negotiation
• Contract interpretation
• Analytics
• Project management

Preferred Software

• Epic
• Oracle ERP/EPM
• Strata
• Advanced Excel
• Power BI/Tableau

Key Performance Indicators

• Net revenue improvement
• Annual reimbursement increases
• Managed care margin
• Contract renewal success
• Underpayment recovery
• Denial reduction
• Value-based contract performance
• Timely contract implementation

About UsMosaic Life Care is a health care system in northwest Missouri. With a vision of transforming community health by being a life-care innovator, Mosaic places the holistic needs of patients first by providing the right care at the right time and place, offering high value and quality health care.Mosaic has a wide array of benefits to meet each employee’s individual needs. Our benefits were designed by listening to people just like you. Mosaic also offers several perks with a focus on ensuring our employees feel valued, including concierge services, employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics and many more. When paired with compensation and recognition, it is what continues to make us the employer of choice for employees at any stage of their journey.