Mgr, Plan Partnerships

PDS Health; Irvine (CA); On-site; USD 103,000 - 133,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Paid time off

Tuition Reimbursement

401K

Volunteer time

Job summary

PDS Health is seeking a Mgr, Plan Partnership to manage strategic relationships with dental and medical payers in the United States. The role supports reimbursement performance, operational efficiency, provider and patient access, and works with internal teams to resolve issues and advance payer strategy.

Responsibilities include managing payer portfolios, negotiating contracts, analyzing reimbursement and trends, and producing executive reports.

Qualifications

• Bachelor's degree in a related field.
• 6+ years of healthcare, dental insurance, managed care, or payer operations experience.
• Experience with commercial insurance, DHMO, PPO, Medicare Advantage and/or Medicaid products.

Responsibilities

• Manage a portfolio of dental and medical payer relationships and partnerships.
• Identify opportunities to improve reimbursement, operations, provider and member experience.
• Support contract negotiations, fee schedules, and implementation activities.
• Analyze claims, utilization, reimbursement trends, and provider performance.
• Prepare reports and executive summaries on partnership performance and financial impact.
• Coordinate cross-functional project plans and stakeholder communications.

Skills

Strategic relationship management

Payer contract negotiations

Healthcare reimbursement expertise

Cross-functional collaboration

Analytical reporting

Leadership and influence

Education

BA/BS in Business/Healthcare Administration/Finance/Public Health

Job description

The Mgr, Plan Partnership manages strategic relationships with dental and medical insurance payors to support reimbursement performance, operational efficiency, provider experience, and patient access. This role partners closely with internal teams and health plan contacts to resolve issues, support contract initiatives, and advance overall payer strategy.

Responsibilities

• Manage a portfolio of dental and medical payer relationships.
• Develop and maintain productive partnerships with health plan representatives.
• Identify opportunities to improve reimbursement, operations, provider experience, and member experience.
• Support long-term payer strategies aligned with organizational goals.
• Support contract negotiations, fee schedule reviews, amendments, and implementation activities.
• Evaluate financial impact of proposed reimbursement and policy changes.
• Coordinate internal review of contract language, reimbursement changes, and operational requirements.
• Monitor implementation of negotiated terms and ensure timely follow-through.
• Serve as the primary contact for escalated payer operational issues.
• Collaborate with Credentialing, Revenue Cycle, Clinical Operations, Legal, Finance, and Network Development to resolve payer concerns.
• Lead recurring business reviews with assigned health plans.
• Track issue resolution and ensure timely follow-up.
• Analyze claims, utilization, reimbursement, denial trends, and provider performance.
• Prepare reports and executive summaries on partnership performance, trends, and financial impact.
• Identify trends and recommend strategic improvements.
• Monitor value-based care and quality program performance metrics.
• Support new payer initiatives, value-based care programs, pilot projects, and benefit changes.
• Coordinate cross-functional project plans, timelines, and stakeholder communications.
• Maintain knowledge of payer policies, regulatory requirements, and contractual obligations.
• Support compliance with payer agreements and internal requirements.
• Document partnership activities and maintain accurate records.
• Ensures compliance with all policies and standards, as well as state, federal and other regulatory bodies.
• This is not intended to be a comprehensive list of the duties and responsibilities of the position and the duties and responsibilities may change.

Qualifications

• Bachelor's Degree in Arts/Sciences (BA/BS) Business, Healthcare Administration, Finance, Public Health, or related field.
• 6+ years of experience in healthcare, dental insurance, managed care, provider relations, payer operations, or a related field.
• Experience working with commercial insurance, DHMO, PPO, Medicare Advantage, and/or Medicaid products.

Preferred

• Experience within a Dental Support Organization (DSO).
• Experience with contract negotiations, fee schedules, and reimbursement methodologies.
• Knowledge of dental coding, claims processing, credentialing, and provider operations.
• Experience supporting value-based care initiatives.

Knowledge/Skills/Abilities

• Strong ability to set short-, mid-, and long-term goals and work with non-PDS entities to drive them to completion.
• Highly developed team-building, influencing, and collaboration skills.
• Ability to direct the work of others and serve as a team leader in attainment of goals.
• Ability to interpret and apply policies and procedures.
• Ability to draw valid conclusions, apply sound judgment in making decisions, and make decisions under pressure.
• Excellent interpersonal and communication skills, with the ability to tailor communication style as needed to a diverse group of carrier contacts.
• Ability to interpret a variety of instructions furnished in written, verbal, or diagram form.
• Ability to multi-task effectively without compromising the quality of the work.
• Excellent interpersonal, oral, and written communication skills.
• Detail-oriented, organized, process-focused, problem solver, proactive, and ambitious.
• Ability to draw conclusions and make independent decisions with limited information.
• Self-motivated, reliable individual capable of working independently as well as part of a team.

Benefits

• Medical, dental, and vision insurance
• Paid time off
• Tuition Reimbursement
• 401K
• Paid time to volunteer in your local community

Compensation Information

$103,000.00-$133,000.00 / Annually

PDS Health is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members.