Vice President of Managed Care

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The Vice President of Managed Care serves as a key member of the hospital's executive leadership team, responsible for driving all aspects of managed care strategy, operations, and performance improvement. This role is essential to ensuring the hospital's financial sustainability and mission-driven delivery of care through strategic payer engagement, effective contract negotiations, and robust compliance oversight.

The VP will develop and execute innovative, data-driven strategies that enhance payer relationships, expand market reach, and optimize reimbursement outcomes. This individual will serve as the hospital's lead negotiator with managed care organizations, ensuring fair, sustainable contracts that support both financial strength and quality patient access.

The ideal candidate is a forward-thinking, results-oriented leader with deep expertise in managed care, a proven record of successful payer negotiations, and the ability to navigate the complex and evolving healthcare landscape.

Hybrid Schedule

• Develop and implement innovative short- and long-term strategies to optimize managed care operations and financial performance.

• Oversee budgeting, staffing, and resource allocation for the Managed Care department.

• Analyze financial and utilization data to identify inefficiencies and drive process improvements.

• Ensure strategies align with the hospital's mission, vision, and business objectives.

Contracting & Negotiations

• Lead high-impact contract negotiations with managed care organizations to secure favorable terms.

• Identify and evaluate new payer opportunities, including Medicaid expansion and exchange plans.

• Partner with legal, actuarial, and consulting experts to support data-informed negotiation and risk assessment.

• Ensure strong contractual language that enforces accountability, compliance, and revenue protection.

Contract Administration & Compliance

• Oversee auditing, performance monitoring, and compliance of managed care contracts.

• Direct reporting and analysis to identify underpayments, discrepancies, and revenue recovery opportunities.

• Evaluate reimbursement models and payment terms for continuous improvement.

• Resolve disputes with payers and ensure adherence to federal, state, and internal compliance standards.

Team Leadership & Development

• Recruit, develop, and manage Managed Care staff, ensuring high performance and accountability.

• Conduct regular performance reviews, team meetings, and professional development planning.

• Ensure all licensures, certifications, and registries are current and properly verified.

Stakeholder Collaboration

• Collaborate with executive and clinical leaders to align managed care strategy with organizational and clinical goals.

• Work with physicians, administrators, and external partners to optimize managed care performance.

• Support initiatives tied to 340B programs, value-based care, and payer collaboration.

Technology & Systems

• Partner with leadership to develop robust information systems that support contract management and analytics.

• Oversee system upgrades and vendor relationships to ensure accuracy, compliance, and efficiency.

Compliance & Ethics

• Maintain expert-level knowledge of managed care regulations and ensure compliance with all applicable laws and standards.

• Model organizational values by promoting quality improvement, patient safety, and cultural diversity.

• Uphold the Code of Conduct and actively participate in compliance and training initiatives.

Minimum Requirements

• Master's degree in a healthcare-related field.

• 7-10 years of progressively responsible experience in managed care administration.

• In-depth knowledge of managed care industry dynamics, including regulatory, actuarial, and competitive factors.

• Strong financial, analytical, and problem-solving skills.

• Excellent negotiation, interpersonal, and communication abilities.

• Demonstrated success in leadership roles across complex healthcare organizations.

• Ability to travel locally and occasionally overnight.

Preferred Qualifications

• Leadership-specific training or certification.

• Lead a mission-driven organization committed to patient-centered care and financial sustainability.

• Shape innovative payer strategies in a dynamic healthcare market.

• Collaborate with forward-thinking leaders dedicated to excellence and integrity.