Director of Managed Care & Contracting Strategy

Mosaic Life Care; Saint Joseph (MO); Vor Ort; USD 180.000 - 240.000; Vollzeit

Benefits dieser Stelle

Concierge services

Employee lounge

Wellness programs

Free parking

On-site and virtual health clinics

Zusammenfassung

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

Qualifikationen

• 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

Aufgaben

• 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.

Kenntnisse

Revenue cycle

Healthcare finance

CMS regulations

Value-based reimbursement

Financial modeling

Negotiation

Contract interpretation

Analytics

Project management

Ausbildung

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

MBA/MHA (Preferred)

Tools

Epic

Oracle ERP/EPM

Strata

Advanced Excel

Power BI/Tableau

Jobbeschreibung

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