Sr. Director of Managed Care Contracting

Lumexa Imaging, Inc.; Chicago (IL); Presencial; USD 160.000 - 230.000; Jornada completa

Descripción de la vacante

LUMEXA IMAGING, INC. seeks a Senior Director, Managed Care Contracting to lead complex payer negotiations, contract execution, and program administration.

This role drives cross-functional collaboration, advises internal stakeholders, reviews contract language, and supports improved reimbursement and operational outcomes. The position emphasizes strategic leadership, relationships with payers, and continuous process improvements in contracting.

Formación

• Minimum 10 years in managed care contracting, payer relations, or healthcare reimbursement.
• 5+ years in leadership overseeing teams and initiatives.
• Experience negotiating complex payer agreements and managing contracts.
• Experience with hospitals, physician organizations, or large multispecialty systems preferred.
• Strong knowledge of managed care contracting, payer reimbursement, and regulatory requirements.
• Proven ability to lead negotiations and influence stakeholders to favorable outcomes.

Responsabilidades

• Establish and maintain relationships with payer representatives and leadership.
• Lead negotiations and execution of contracts within financial and language parameters.
• Collaborate with legal counsel to review contract language and standards.
• Prepare data and analyses for negotiations and for trend/operational issues.
• Guide department teams in planning, renewals, and performance assessment.
• Ensure timely contracting for acquisitions and new facilities.
• Resolve contract-related claims and issues in collaboration with revenue cycle teams.
• Communicate new terms to internal customers.
• Develop and maintain department tracking documents.
• Manage special projects as required.

Conocimientos

Contract negotiation

Leadership

Strategic planning

Data analysis

Relationship management

Cross-functional collaboration

Project management

Regulatory compliance

Communication

Team development

Educación

Bachelor's degree in Business Administration, Healthcare Administration, Finance, Law, or related field

MBA / MHA / MPH / JD preferred

Herramientas

Contract management systems

Microsoft Office applications

Healthcare financial and claims reporting tools

Descripción del empleo

The Senior Director, Managed Care Contracting for Lumexa Imaging provides strategic leadership for the negotiation, execution, and administration of managed care payer agreements to support the organization's financial and operational objectives. This role oversees complex contract negotiations, evaluates contract language, collaborates with internal and external legal counsel, collaborates cross-functionally to develop negotiation strategies and resolve contract-related issues, and ensures timely implementation and communication of contractual terms. The Senior Director also drives continuous improvement of contracting processes, provides subject matter expertise and guidance to internal stakeholders, and leads special projects and initiatives that enhance the effectiveness of the managed care contracting function.

Essential Duties and Responsibilities:

• Establish, build and maintain positive working relationships with payer representatives and leadership, and serve as the primary relationship manager with these individuals within assigned geographies and/or projects.
• For geographies or partner companies that are part of a joint venture relationship, collaborate with the joint venture managed care and other colleagues to accomplish the joint managed care contracting and operational targets.
• Lead the process of negotiation and execution of contracts with managed care payers and other third parties, within financial and language parameters established by the Managed Care Department leadership, including working directly to complete negotiations and execute contracts
• Collaborate with internal and external legal counsel to review, evaluate and document new and existing payer contract language compared to department language standards and regulatory language
• Perform ad hoc contract language review/analysis
• Serve as an internal resource for responding to payer contract language questions/requests
• Work with financial analysts and other department/company team members to prepare appropriate data/analysis for negotiations and for trended claim/operational issues
• Develop and provide guidance for other department team members for managing the planning process for contract negotiations and renewals, including assessment of historical performance and opportunities
• Ensure completion of contracting for acquired/new facilities and practices
• Manage resolution of contract-related claims and operational issues by proactively researching the issues and working with both internal and external customers and/or through collaboration with the Managed Care Operations Director and/or the revenue cycle team.
• Ensure new and revised contract terms are communicated to internal customers
• Develop and maintain department tracking documents
• Manage special projects as required
• Other duties as assigned

Education & Experience

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, Law, or a related field required.
• Master's degree in Business Administration (MBA), Healthcare Administration (MHA), Public Health (MPH), or Juris Doctor (JD) preferred.
• Minimum of 10 years of progressively responsible experience in managed care contracting, payer relations, or healthcare reimbursement, including extensive experience negotiating complex payer agreements.
• Minimum of 5 years of leadership experience with responsibility for managing teams, projects, and organizational initiatives.
• Experience working with hospitals, physician organizations, integrated delivery systems, or large multi-specialty healthcare organizations preferred.
• Demonstrated success developing and implementing contracting strategies that improve reimbursement, operational performance, and organizational outcomes.

Knowledge, Skills & Abilities

• Expert knowledge of managed care contracting principles, payer reimbursement methodologies, and healthcare payment models, including fee-for-service, value-based reimbursement, and alternative payment arrangements.
• Comprehensive understanding of commercial, Medicare Advantage, Medicaid managed care, and other third-party payer contracting practices.
• Strong knowledge of healthcare regulatory requirements affecting managed care contracting, reimbursement, and compliance.
• Advanced contract negotiation, drafting, interpretation, and contract language analysis skills.
• Exceptional financial and analytical skills with the ability to evaluate reimbursement methodologies, identify trends, and develop data-driven negotiation strategies.
• Demonstrated ability to lead complex negotiations and influence internal and external stakeholders to achieve favorable outcomes.
• Strong strategic planning, project management, and organizational skills with the ability to manage multiple priorities and deadlines.
• Excellent written, verbal, and presentation communication skills.
• Proven ability to build collaborative relationships across executive leadership, operations, finance, legal, revenue cycle, and clinical teams.
• Strong leadership, coaching, and team development skills with experience fostering a high-performing, collaborative work environment.
• Ability to exercise sound judgment, maintain confidentiality, and make informed decisions in complex or sensitive situations.
• Proficiency with Microsoft Office applications, contract management systems, and healthcare financial and claims reporting tools.