Director of Managed Care

Nightingale; Garfield Heights (OH); Remote; USD 110,000 - 160,000; Full time

Benefits offered by this job

Fully remote

Competitive compensation

Job summary

Nightingale is seeking a Director of Managed Care to oversee prior authorizations, payer coordination, and utilization management across six skilled nursing facilities in Arkansas and Ohio. The role is fully remote, requiring deep expertise in Medicare Advantage and commercial plans and strong cross-team collaboration with MDS, nursing leadership, and regional teams.

You will optimize reimbursements, monitor authorization timelines, and resolve denials while maintaining compliant documentation

Qualifications

• Deep background in Managed Care, Utilization Review, Prior Authorization, or MDS within SNF/LTC.
• Strong understanding of Medicare Advantage and commercial plans.
• Excellent communication, follow-through, and problem-solving skills.

Responsibilities

• Manage and process all prior authorizations for admissions, continued stays, therapy services, and specialty care.
• Serve as the primary contact for managed care organizations, insurance plans, and payer representatives.
• Monitor authorization timelines, length of stay, and payer requirements to ensure compliance.
• Collaborate daily with MDS, nursing leadership, therapy, admissions, and regional leadership.
• Track, resolve, and appeal denials, ensuring complete and accurate documentation.
• Provide clear, consistent communication to facility teams regarding authorization status and next steps.
• Identify trends, barriers, and opportunities to strengthen managed care outcomes.
• Maintain organized workflows and reporting across all six facilities.

Skills

Managed Care

Utilization Review

Prior Authorization

MDS

Communication

Remote work

Job description

Director of Managed Care

Remote Position

RN/LPN Preferred

Job Summary:

We are seeking an experienced, detail-driven Director of Managed Care to oversee prior authorizations, payer coordination, and utilization management across six skilled nursing facilities in Arkansas and Ohio. As a key member of our team, you will ensure timely authorizations, accurate documentation, and strong communication with payers to optimize reimbursement and resident care.

Responsibilities:

• Manage and process all prior authorizations for admissions, continued stays, therapy services, and specialty care

• Serve as the primary contact for managed care organizations, insurance plans, and payer representatives

• Monitor authorization timelines, length of stay, and payer requirements to ensure compliance

• Collaborate daily with MDS, nursing leadership, therapy, admissions, and regional leadership

• Track, resolve, and appeal denials, ensuring complete and accurate documentation

• Provide clear, consistent communication to facility teams regarding authorization status and next steps

• Identify trends, barriers, and opportunities to strengthen managed care outcomes

• Maintain organized workflows and reporting across all six facilities

Requirements:

• Strong background in Managed Care, Utilization Review, Prior Authorization, or MDS within SNF/LTC

• Deep understanding of Medicare Advantage, commercial plans, and authorization processes

• Excellent communication, follow-through, and problem-solving skills

• Ability to manage multiple facilities, deadlines, and payer relationships

• Highly organized, tech-savvy, and comfortable working fully remote

• Proactive, positive, team-focused professional who thrives in a collaborative environment

Your expertise ensures residents receive timely approvals, facilities maintain accurate reimbursement, and teams across Arkansas and Ohio stay aligned and supported. You'll be the central hub that keeps managed care operations running smoothly.

Why Join Us:

• Fully remote role

• Supportive, mission-driven leadership

• Opportunity to impact outcomes across multiple communities

• Competitive compensation

• A role where your work directly strengthens resident care and operational success

If you're passionate about managed care excellence and excited to support six dedicated healthcare teams across Arkansas and Ohio, we want to meet you.