Director of Managed Care and Contracting (51476)

Director of Managed Care and Contracting (51476)Performance Home Medical has been a leader in providing quality products and services since 1995.At Performance Home Medical (PHM), our patients come first. We use the latest technology with compassionate clinical support to empower individuals in managing their conditions, helping them live longer, healthier, and more independent lives.We are seeking a dynamic, strategic, and results-driven Director of Managed Care and Contracting to lead and optimize our payer strategy and provider agreements. This key leadership role is responsible for developing, negotiating, and managing managed care contracts that align with our organization’s financial goals and patient care priorities. The ideal candidate will bring leadership qualities that resonate with the collaborative and mission-driven culture at Performance Home Medical, a leading provider of medical supplies.This remote position provides support across our markets in Washington, Oregon, Idaho, and Texas.Position SummaryThe Director of Managed Care and Contracting is responsible for developing, negotiating, and managing payor contracts to ensure optimal reimbursement and access for Performance Home Medical’s respiratory services. This role plays a critical part in shaping the company’s payor strategy, maintaining strong relationships with insurance partners, and ensuring compliance with regulatory and contractual obligations.ResponsibilitiesContract Strategy & NegotiationLead the development and execution of managed care strategies aligned with business goals.Negotiate and manage contracts with commercial payors, Medicare Advantage, Medicaid HMOs, and other third-party payors.Evaluate reimbursement models and recommend improvements to optimize revenue.Payor RelationsServe as the primary liaison with insurance companies and managed care organizations.Foster collaborative relationships to support favorable contract terms and issue resolutions.Develop and deliver compelling presentations on Performance Health’s chronic disease clinical programs.Financial & Operational OversightAnalyze contract performance, utilization trends, and financial impact.Collaborate with finance and billing teams to ensure accurate reimbursement and claims pliance & Risk ManagementEnsure all contracts comply with federal, state, and industry regulations.Monitor changes in healthcare policy and payor requirements, adjusting strategies accordingly.Leadership & CollaborationPartner with clinical, sales, and operations teams to align payor strategies with service delivery.QualificationsEssential SkillsAdaptability - Accepts and applies feedback. Adapts to changes in the work environment. Changes approach or method to best fit the situation; manages competing demands.Professionalism - Arrives and begins work prepared and on time; maintains professional conduct and mitment to Quality – Demonstrates competence, continuous learning, and pursuit of development opportunities.Teamwork – Builds positive team spirit and collaborates toward shared munication - Listens, communicates clearly, and presents data anizational Development - Builds trust, maintains records, supports process improvements, and drives stakeholder satisfaction.Leadership Management - Delegates, sets expectations, and supports teams through change.Education and ExperienceBachelor’s degree in healthcare or business administration preferred, or related experience. 7+ years of managed care contracting and relationship management experience, preferably in respiratory or home medical equipment (HME) sectors. Strong negotiation, analytical, and communication skills. Deep understanding of payor reimbursement methodologies and regulatory frameworks.Other SkillsLanguage Ability: Read, analyze, and interpret complex documents; respond effectively to sensitive inquiries; create presentations and articles; make persuasive presentations on complex topics to management and public groups.Mathematical Ability: Analyze data.Reasoning Ability: Solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists; interpret a variety of puter Skills: Proficient with Microsoft Office (Word, PowerPoint, Outlook, Chrome, Internet Explorer, SharePoint).Certificates, Licenses, RegistrationsValid State Driver’s license in residing state.Travel RequirementsTravel up to 50% as needed within region/territory. Have reliable means of transportation. Meet the requirements of our Motor Vehicle policy.All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.Job DetailsSeniority level: DirectorEmployment type: Full-timeJob function: Health Care ProviderIndustries: Hospitals and Health Care #J-18808-Ljbffr

Created: 2025-10-08