Director, Managed Care - Great Lakes Region

AdaptHealth; United States; On-site; USD 150,000 - 190,000; Full time

Job summary

AdaptHealth seeks a Director of Managed Care to lead strategic partnerships with payors, post-acute providers, and health systems. You will drive new business through clinical integration, market expansion, and revenue growth while guiding cross-functional teams and ensuring contract compliance.

The role demands expert negotiation, strong analytics, and a demonstrated ability to manage complex healthcare contracts. HIPAA compliance and deep industry knowledge are essential.

Qualifications

• Proven leadership abilities and experience in managing teams.
• Strong contract negotiation skills and strategic thinking.
• Knowledge of medical contracting methodologies and reimbursement strategies.
• Independent thinker able to make sound decisions.
• Excellent analytical and problem-solving capabilities with attention to detail.

Responsibilities

• Lead strategic partnerships for the company with payors, post-acute providers, and health systems.
• Guide cross-functional teams including Operations, Sales, Billing and Finance.
• Ensure timely setup and ongoing maintenance of contracts with payors, facilities, and other entities.
• Lead and assist with RFP processes and responses.
• Resolve complex issues with minimal supervision and resource awareness.
• Serve as SME on contract and reimbursement topics impacting home medical equipment business.
• Manage a portfolio of clients to identify and deliver business opportunities.
• Coordinate with Audit and Compliance to stay in good standing.
• Engage with Post-Acute market relations and corporate accounts.
• Maintain knowledge of AdaptHealth products and services and HIPAA compliance.

Skills

Proven leadership skills

Contract negotiations

Medical contracting

Independent thinking

Analytical skills

Communication

Strategic partnerships

Excel

Prioritization

Data fluency

Education

Bachelor’s degree in relevant discipline

Job description

Position Summary

The Director, Managed Care is responsible for strategic partnerships with Managed Care Organizations, Post-Acute providers, and Health systems, including new business and revenue development through continued clinical integration and market expansion. Assists with business operations, audit/compliance, and analytical support. Advises senior management of business opportunities and strategies.

Description

The Director, Managed Care is responsible for strategic partnerships with Managed Care Organizations, Post-Acute providers, and Health systems, including new business and revenue development through continued clinical integration and market expansion. Assists with business operations, audit/compliance, and analytical support. Advises senior management of business opportunities and strategies.

Essential Functions And Job Responsibilities

• Leads and advances Strategic Partnerships for the Company, including clinical integration, enhancements in reimbursement, and innovative development, which includes negotiating alternative payment mechanisms, risk-sharing, and/or other reimbursement tactics to increase revenue.
• Provides guidance and direction to cross-functional business team members including Operations, Sales, Billing and/or Finance.
• Ensures timely and accurate setup and ongoing maintenance of contracts with contracted entities including, but not limited to payors, facilities, subcontractors, and other legal entities.
• Leads and assists with RFP’s.
• Solves complex issues in a timely and appropriate manner with minimal management oversight and attention to resources.
• Serves as a subject matter expert on contract and reimbursement-related issues impacting the home medical equipment and supplies business and healthcare industries, particularly with a managed care and commercial reimbursement focus.
• Manages a portfolio of clients to identify and deliver on business opportunities and projects.
• Works with Audit and Compliance to ensure company stays in good standing with associated entities, regulations, and patients.
• Experience calling on the Post-Acute market (Medical Groups, At-risk programs, home based programs)
• Corporate Account and Business Development experience
• Health system experience
• Strategic partnerships
• Effectively evaluates and oversees TPA, as company moves forward with possible integration options.
• Develops and maintains working knowledge of current HME products and services offered by the company.
• Maintains patient confidentiality and functions within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliant with AdaptHealth’s Compliance Program and applicable company policies, procedures, and patient protocols.
• Performs other related duties as assigned.

Management/Supervision

• Responsible for selection and hiring of qualified staff, ensuring an effective on-boarding, and providing comprehensive training and regular feedback.
• Accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards.
• Establishes annual goals and objectives for the department based on the organization’s strategic goals.
• Responsible for achieving organizational performance and retention goals, including timely completion of performance evaluations.

Compensation based on experience, location and role level: $150,000-190,000

Requirements

Competency, Skills, and Abilities

• Proven leadership skills
• Ability to handle complex contract negotiations.
• Proficient knowledge of medical contracting methodologies and claims pricing/reimbursement strategies
• Independent thinker and decision maker
• Strong analytical and problem-solving skills with attention to detail
• Excellent verbal and written communication
• Strategic business partner
• Proficient computer skills and knowledge of Microsoft Office specifically Excel
• Ability to prioritize and manage multiple projects.
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.

Education And Experience Requirements

• Bachelor’s degree in relevant discipline from an accredited college required.
• Seven (7) years of relevant work experience required in contracting, credentialing, or network management.
• Five (5) years of management experience in related position is preferred.
• Valid and unrestricted driver’s license in the state of residence