Director of Managed Care & Payer Strategy

Phoenix Children's Hospital, Inc.; Phoenix (AZ); On-site; USD 180,000 - 240,000; Full time

Job summary

Phoenix Children's Hospital, Inc. seeks a Director of Managed Care to lead the contract lifecycle, including negotiation, implementation, and coordination of third-party payer agreements for the enterprise.

The role oversees Provider Enrollment and Payer Relations, ensuring timely enrollment and productive relationships with payers. The position reports to the VP, Managed Care and supports PC, PCMG, and PCCN contracts.

Qualifications

• Bachelor's degree or five years of managed care supervisory experience required.
• Master's degree preferred.
• Ten or more years of managed care experience required.
• Five years supervisory experience required.
• Three years of comprehensive managed care contracting experience in IDN/ACO/health plan.
• Extensive knowledge of contracting negotiations, reimbursement methodologies, risk contracts, and related regulations.
• Experience with facility and professional billing systems, CPT/HCPCS codes, and revenue codes.

Responsibilities

• Directs all contracting activities for the enterprise-wide payer contract portfolio.
• Oversees enrollment of facilities and employed providers with payers.
• Manages payer relations to maintain productive relationships for contract development.
• Educates network providers on managed care principles and contract changes.
• Leads cross-functional teams to implement contracting strategies and negotiations.
• Performs miscellaneous job-related duties as requested.

Education

Bachelor's degree in finance, health administration, or related field; OR five (5) years of managed care supervisory experience

Master's degree

Tools

Microsoft Office (Word, Excel, Outlook, PowerPoint)

Job description

Phoenix Children's Hospital, Inc. seeks a Director of Managed Care to lead the contract lifecycle, including negotiation, implementation, and coordination of third-party payer agreements for the enterprise.

The role oversees Provider Enrollment and Payer Relations, ensuring timely enrollment and productive relationships with payers. The position reports to the VP, Managed Care and supports PC, PCMG, and PCCN contracts.