Strategic Director, Managed Care & Credentialing

SIU Medicine; Springfield (IL); On-site; USD 120,000 - 180,000; Full time

Job summary

SIU Medicine in Springfield, IL seeks an experienced Director of Managed Care Contracting & Provider Credentialing to provide strategic leadership and financial oversight of managed care contracting and credentialing across SIU Medicine's network.

You will oversee credentialing policy development, contract management, and payer relations, ensuring compliant enrollment and timely privileging across the organization.

Qualifications

• Knowledge of health insurance claim data and managed care payment methodologies.
• Understanding of Federal and State regulatory environment for Managed Care.
• Experience negotiating Managed Care contracts with payers or on behalf of a managed care organization.

Responsibilities

• Lead development and execution of SIU Medicine's managed care strategy and contract portfolio.
• Oversee credentialing and privileging across a multispecialty network.
• Manage hospital/facility privileging, enrollment, and payer communications.
• Monitor contract performance, renewals, and provider participation with payers.

Skills

Health insurance data knowledge

Managed Care payment methodologies

Regulatory environment knowledge

Education

Bachelor's Degree in Healthcare Administration or related field

Master's Degree (desired)

Job description

SIU Medicine in Springfield, IL seeks an experienced Director of Managed Care Contracting & Provider Credentialing to provide strategic leadership and financial oversight of managed care contracting and credentialing across SIU Medicine's network.

You will oversee credentialing policy development, contract management, and payer relations, ensuring compliant enrollment and timely privileging across the organization.