Director of Managed Care and Credentialing

We are seeking an experienced Director of Managed Care for our revenue cycle management (RCM) company. We are looking for someone who puts our clients first and oversees managed care contract negotiations, ensures that the credentialing process is meeting deadlines, and ensures compliance with payer requirements and regulations for all managed care plans. We are looking for a company leader who also is hands-on, and can lead a small team effectively. We are also looking for a collaborator, one who can work effectively with our operations and client success teams.

Key Responsibilities:

• Contract Management: Lead the entire contract lifecycle, from strategic planning and negotiation to implementation and ongoing management of contracts with commercial, government (Medicare/Medicaid), and other payers.
• Credentialing Oversight: Manage and streamline the provider credentialing and re-credentialing process for accuracy and efficiency.
• Payer Relations: Develop and maintain strong relationships with payers, negotiating contracts and staying updated on their requirements.
• Financial Analysis: Analyze contract performance, identify cost reduction opportunities, and develop strategies to maximize net revenue and drive favorable reimbursement rates.
• Strategic Planning: Develop and implement strategic initiatives for payer engagement, value-based care, and market positioning to align with organizational goals.
• Client Relations: Build and maintain strong relationships with clients/healthcare providers and other stakeholders to foster partnerships and ensuring exceptional client service and satisfaction.
• Compliance & Operations: Ensure compliance with managed care regulations and contractual obligations and credentialing deadlines, and oversee the administrative and operational aspects of managed care programs.
• Leadership & Collaboration: Serve as a department leader and key liaison, collaborating with client success, operations, and executive leadership to ensure alignment and strategic execution. Managing credentialing team members.

Essential Skills and Knowledge:

• Managed Care Principles: A deep understanding of healthcare reimbursement models, population health, clinical integration, and regulatory changes.
• Hospital-Based Physician Group Expertise: Understanding of specific needs of the hospital-based physician groups, with pathology experience preferred.
• Negotiation & Communication: Strong negotiation skills and the ability to communicate effectively with diverse stakeholders, including C-suite executives and payer representatives.
• Analytical Skills: The ability to analyze complex financial reports, contract terms, and utilization data to inform strategic decisions.
• Strategic Thinking: The capacity to develop long-term strategies that align with industry trends and organizational growth goals.
• Team Leadership: Lead and develop teams responsible for the operational excellence of both credentialing and managed care contracts.

While this position can be remote, we would ideally prefer someone in the Houston area to visit our offices for team collaboration meetings.