National Director of Managed Care

90010 ClearSky Health Acquisition, LLC; 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

Our hospitals provide high-quality care that transforms the lives of those living with disabling injuries and illnesses. We distinguish ourselves through our commitment to excellence, to our patients, to our employees, and to the communities we serve.

We are looking for a National Director of Managed Care to join our growing team! This position will provide strategic leadership for managed care operations across the organization. This role drives patient access, referral growth, and revenue performance by developing payer partnerships, optimizing prior authorization processes, and strengthening collaboration among health plans, physicians, and hospital teams. The Director works closely with payer medical directors and clinical admissions teams to reduce barriers to admission, improve authorization outcomes, minimize denials, and support timely transitions of appropriate patients into inpatient rehabilitation.

Essential Functions Minimum Job Requirements

• 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 appropriately reflect IRF requirements.
• Lead improvements to referral intake and prior authorization processes to accelerate referral decisions, reduce operational turnaround times, and increase timely admissions.
• Collaborate with clinical liaisons, case managers, and rehabilitation physicians to ensure documentation clearly supports admission and coverage requirements before submission.
• Intervene in complex or delayed authorization requests and facilitate reviews between payer medical directors and physicians to help resolve issues.
• Lead strategic efforts to appeal payer denials, identify trends, and develop strategies, education, and processes that reduce further 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 measurable improvements in patient access, admissions, and reimbursement.
• Establish and lead regular meetings with key payers to address authorization challenges, resolve utilization issues, authorization challenges, and strengthen working relationships.

Minimum Education & Experience

• Bachelor’s degree in healthcare administration, business administration, nursing, or a related field required.
• Master’s Degree (MHA, MBA, MSN) preferred.
• Direct experience in healthcare leadership may be substituted for 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.

Required Licenses, Certifications, and/or Documentation

• Must maintain acceptable driving record, current driver’s license, and insurability.

Required Knowledge, Skills, and Abilities

• Advanced knowledge of Medicare Advantage (Part C) utilization management structures, clinical guidelines, and prior authorization regulations.
• Comprehensive knowledge of post-acute operational models and CMS medical necessity requirements.
• Knowledge of payer types in the healthcare industry.
• Demonstrates effective conflict resolution in customer service.
• Ability to travel between markets.

Physical Requirements over the Course of a Shift

• A significant amount of standing, often for prolonged periods of time.
• Both gross and precise motor functions.
• Sufficient manual dexterity to operate equipment and computer keyboard.
• Close vision and the ability to adjust focus.

Why Join ClearSky Health?

Join a growing organization dedicated to delivering exceptional rehabilitation outcomes while transforming patient access to care. This role offers the opportunity to influence enterprise-wide strategy, build meaningful payer partnerships, and drive measurable impact across a national hospital network.

Authentic. Inspiring. Transformative.

ClearSky Health and our affiliated Hospitals provide high-quality care that transforms the lives of those living with disabling injuries and illnesses. We distinguish ourselves through our commitment to excellence, to our patients, to our employees, and to the communities we serve.

We value our employees’ skills, talents, and input. We believe in maintaining hospital environments where employees are:

• Valued Treated with dignity Respected Provided educational and training opportunities Recognized Rewarded

ClearSky Health has plans to open a medical rehabilitation hospital at the location listed below.

• Eau Claire, WI
• Beloit, WI
• Casa Grande, AZ
• Seneca, SC
• Smithfield, NC