National Director, Managed Care & Payer Partnerships

ClearSky Health; Albuquerque (NM); Remote; USD 150,000 - 230,000; Full time

Job summary

ClearSky Health is seeking a National Director of Managed Care to lead payer strategy across our inpatient rehabilitation network. You will drive patient access, referrals, and revenue by building payer partnerships, optimizing prior authorizations, and collaborating with plans, physicians, and hospital teams.

This role requires deep knowledge of Medicare Advantage and CMS medical necessity requirements, plus the ability to travel between markets to align contracting, utilization, and denial

Qualifications

• Bachelor’s degree required in healthcare administration, business administration, nursing, or related field.
• Master’s Degree (MHA, MBA, MSN) preferred; direct experience may substitute education on a year-for-year basis.
• 5 years’ progressive leadership experience in healthcare managed care, utilization review, or payer relations required.
• Experience with CMS medical necessity requirements and IRF experience preferred.

Responsibilities

• Serve as primary liaison to national and regional Medicare Advantage plans, promoting the clinical and financial value of inpatient rehabilitation services, and strengthening payer relationships.
• Partner with contracting teams to negotiate, implement, and monitor payer contracts, ensuring reimbursement structures reflect IRF requirements.
• Lead improvements to referral intake and prior authorization processes to accelerate referral decisions and admissions.
• Collaborate with clinical liaisons, case managers, and rehabilitation physicians to ensure documentation supports admission and coverage requirements.
• Intervene in complex or delayed authorization requests and facilitate reviews between payer medical directors and physicians to resolve issues.
• Lead strategic efforts to appeal payer denials, identify trends, and develop strategies to reduce denials.
• Monitor and report key performance metrics including payer-specific referral-to-admission conversion rates, authorization turnaround times, denial rates, and length-of-stay variations.
• Collaborate with admissions, clinical, utilization review, revenue cycle, contracting, and hospital leadership teams to implement payer-specific action plans and drive improvements in patient access, admissions, and reimbursement.
• Establish and lead regular meetings with key payers to address authorization challenges and strengthen working relationships.

Skills

Medicare Advantage knowledge

Utilization management

Payer relations

Leadership

Travel flexibility

Education

Bachelor’s degree in healthcare administration, business administration, nursing, or related field

Master’s Degree (MHA, MBA, MSN) preferred

Job description

ClearSky Health is seeking a National Director of Managed Care to lead payer strategy across our inpatient rehabilitation network. You will drive patient access, referrals, and revenue by building payer partnerships, optimizing prior authorizations, and collaborating with plans, physicians, and hospital teams.

This role requires deep knowledge of Medicare Advantage and CMS medical necessity requirements, plus the ability to travel between markets to align contracting, utilization, and denial