Remote Director of Managed Care & Payer Operations

Nightingale; Little Rock (AR); Remote; USD 110,000 - 150,000; Full time

Benefits offered by this job

Fully remote

Competitive compensation

Impact across six communities

Job summary

Nightingale seeks an experienced Director of Managed Care to oversee prior authorizations, payer coordination, and utilization management across six skilled nursing facilities in Arkansas and Ohio. This fully remote leadership role ensures timely authorizations, accurate documentation, and proactive payer communications to optimize reimbursement and resident care.

You will manage authorizations for admissions, continued stays, therapy services, and specialty care; serve as the primary contact

Qualifications

• Strong background in Managed Care, Utilization Review, Prior Authorization, or MDS within SNF/LTC.
• Deep understanding of Medicare Advantage, commercial plans, and authorization processes.
• Excellent communication, follow-through, and problem-solving skills.
• Ability to manage multiple facilities, deadlines, and payer relationships.
• Highly organized, tech-savvy, and comfortable working fully remote.
• Proactive, positive, team-focused professional who thrives in a collaborative environment.

Responsibilities

• Manage and process all prior authorizations for admissions, continued stays, therapy services, and specialty care.
• Serve as the primary contact for managed care organizations, insurance plans, and payer representatives.
• Monitor authorization timelines, length of stay, and payer requirements to ensure compliance.
• Collaborate daily with MDS, nursing leadership, therapy, admissions, and regional leadership.
• Track, resolve, and appeal denials, ensuring complete and accurate documentation.
• Provide clear, consistent communication to facility teams regarding authorization status and next steps.
• Identify trends, barriers, and opportunities to strengthen managed care outcomes.
• Maintain organized workflows and reporting across all six facilities.

Skills

Managed Care

Utilization Review

Prior Authorization

MDS (SNF/LTC)

Medicare Advantage

Commercial Plans

Authorization Processes

Communication

Problem-Solving

Remote Work

Job description

Nightingale seeks an experienced Director of Managed Care to oversee prior authorizations, payer coordination, and utilization management across six skilled nursing facilities in Arkansas and Ohio. This fully remote leadership role ensures timely authorizations, accurate documentation, and proactive payer communications to optimize reimbursement and resident care.

You will manage authorizations for admissions, continued stays, therapy services, and specialty care; serve as the primary contact