Senior Director Managed Care - Hybrid

This is a hybrid position based at our beautiful corporate office located in Brentwood, TN, with on-site work required Monday through Wednesday.

DUTIES AND RESPONSIBILITIES

Lead contract negotiations and actively manage payer agreements for assigned hospitals, ASCs, and physician groups, including commercial, Medicare Advantage, Medicaid managed care, workers' compensation, exchange, and self-funded employer plans. Partner with facility, physician group, and operational leadership to develop and execute payer contracting strategies aligned with organizational growth, reimbursement, and financial objectives. Establish and manage annual contract rate increase budgets and reimbursement goals for assigned facilities, maintaining accountability for achieving or exceeding financial targets. Conduct due diligence for acquisitions by reviewing payer contracts, reimbursement structures, claims payment accuracy, and market opportunities for contract improvement. Analyze reimbursement models, contract proposals, payment methodologies, and financial scenarios to support negotiation strategy and evaluate revenue impact. Collaborate with analysts, revenue cycle, and business office teams to identify reimbursement discrepancies, underpayments, overpayments, and contract compliance issues. Monitor post-implementation contract performance to validate reimbursement outcomes, identify variances from modeled expectations, and address payer compliance concerns. Build and maintain effective relationships with payer representatives, provider relations teams, senior negotiators, and internal stakeholders across operations, finance, and physician leadership. Communicate negotiation strategies, contract renewals, market conditions, and key payer initiatives to executive and operational leadership through regular updates and presentations. Support reimbursement optimization initiatives, including charge strategy recommendations, chargemaster updates, contract amendments, and implementation of automatic rate escalators. Maintain contract documentation, summaries, and repositories while ensuring accurate contract interpretation, operational handoff, and system documentation. Participate in managed care projects, reimbursement initiatives, market research, legislative support activities, and educational efforts related to payer trends, market changes, and value-based care.

QUALIFICATIONS EDUCATION

Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field required; Master's degree preferred.

EXPERIENCE

Minimum of 7 years of negotiation experience for hospitals, ASCs with major commercial payors with 5 years of leadership experience. Experience working with clinically integrated networks, ACO's, or other population health initiatives a plus, but not required. Experience working with payors and billing office staff to resolve payment discrepancies. LICENSE(S)/CERTIFICATION(S) Certified Managed Care Executive (CMCE) or similar certification preferred.

KNOWLEDGE/SKILLS/ABILITIES

Extensive knowledge of managed care principles, contract negotiation, healthcare reimbursement methodologies, and regulatory requirements. Strong analytical, communication, and leadership skills. Excellent quantitative and analytical skills, with attention to detail to ensure that modeling for negotiations is accurate. Moderate knowledge of Excel. Solid understanding of payer contract reimbursement methodologies and application of payor policies on reimbursement expected under existing and future agreements. Strong writing skills and ability to communicate effectively in order to negotiate key terms for payor agreements. Strong understanding of healthcare industry trends in payor negotiations including contract language, product development trends, pay for performance programs, bundled payment programs, etc. Solid understanding of billing methodologies by ASCs/hospitals. Ability to review a hospital or ASC claim and determine if the payor reimbursed the claim accurately or not as a result of how it was billed.

CORE COMPETENCIES

Strategic thinking, negotiation, financial acumen, relationship management, problem-solving, and team leadership.

WORKING CONDITIONS PHYSICAL REQUIREMENTS

Physical Requirements Occasionally 0

• 33% Frequently 34
• 66% Constant 67
• 100% Talk / Hear X See X Sit X Repetitive Use of Hands X Hazards and Atmospheric Conditions Conditions Selected Normal Office Surroundings

X COMPETENCIES

Agility Resourcefulness:

Adapts quickly to changing circumstances; cleverly navigates obstacles and constraints.

Manages Uncertainty:

Comfortable when things are in flux; readily shifts approach or behavior to fit changing circumstances. Bias to

Action Action Oriented:

Propensity to act or decide and move forward with a logical approach; can decide and act without having the total picture.

Delivering Results:

Strives for high levels of achievement; maintains a clear and steady focus on meeting goals, despite obstacles; is resilient when encountering setbacks. Customer Focus Identifying with

Customers:

Understanding who the external and internal customers are and what they value.

Managing Complexity Essence:

Extracts the core meaning out of complex situations; can separate the important from the noise when problem solving; hunts for the root cause of successes and failures.

Manages Conflict:

Can hammer out tough agreements and settle disputes equitably. Stays positive, constructive, and respectful, even in disagreements or conflicts.

Capability BuildingHelps Others Succeed:

Steps aside and lets others shine; serves as a mentor and coach; helps others apply their strengths and shore up on their weaknesses.

Interpersonal Impact People Smart:

Reads people well: can articulate the qualities, perspectives, strengths, and weaknesses of others.

Influence:

Even without direct authority finds common ground and win/win solutions; gaining alignment on the path forward.

Strategic Vision Inspires Others:

Creates common purpose/shared mind-set; raises other's confidence to tackle challenges; promotes high level of energy and excitement.

Visioning:

Can anticipate future consequences and trends; articulately paints credible pictures of possibilities and likelihoods.

Benefits:

Comprehensive health, dental, and vision insurance Health Savings Account with an employer contribution Life Insurance PTO 401(k) retirement plan with a company match And more!

ENVIRONMENTAL/WORKING CONDITIONS

: Normal busy office environment with much telephone work. Possible long hours as needed. The description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

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No Recruiters Please Disclaimer:

Disclaimer:

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.