Job Description
Job DescriptionOverview
As a vital leader in Otterbein's mission to enrich individual life journeys for all, the Director of Managed Care will lead the organization's managed care strategy across post-acute and skilled nursing settings. This position serves as the internal and external expert on managed care contracts, payer relations, and value-based care initiatives. In collaboration with clinical, operational, and financial teams, the Director will drive financial performance, improve payer relationships, and implement processes to enhance managed care outcomes and revenue integrity.
Primary Duties and Responsibilities
- Lead day-to-day execution of the managed care strategy across all Otterbein locations.
- Serve as the organization's expert and primary contact for all managed care-related matters.
- Partner with local leaders to educate and guide on payer contracts, expectations, and authorizations.
- Participate in and support the appeal and denial management process.
- Act as the primary liaison to external entities including OASN and Kairos Health Systems.
- Negotiate and manage payer contracts to ensure favorable terms and performance metrics.
- Develop and maintain a reporting structure for managed care income and expense by payer.
- Deliver regular analysis and actionable recommendations to senior leadership.
- Build and maintain a comprehensive managed care contract library segmented by payer, location, and line of business.
- Standardize and automate managed care-related processes across the organization.
- Collaborate with IT and finance to build an automated dashboard integrating key metrics (e.g., carve-outs, denials, LOS).
- Partner with Marketing and Operations to identify and remove admission barriers related to payer contracts.
- Assist in preparing and executing Value-Based Purchasing and Quality-related measures.
- Analyze organizational needs to determine the most effective case management model (centralized vs. decentralized).
Experience & Qualifications
- Bachelor's degree in Health Administration, Business, or a related field; Master's degree preferred.
- Minimum 5–7 years of experience in managed care contracting, preferably in post-acute or skilled nursing settings.
- Strong understanding of CMS regulations, SNF reimbursement, and the 5-Star Quality Rating System.
- Demonstrated success in managed care strategy, contract negotiation, and relationship management.
- Proficiency in payer financial analysis, revenue cycle impact, and cost structure modeling.
- Experience in building automated reporting tools/dashboards; familiarity with tools like Power BI is a plus.
BENEFITS*
Health & Wellness
- Medical Insurance with free virtual doctor visits
- Vision & Dental Insurance
- Pet Insurance
- Life Insurance
- Employee Assistance Program (EAP) for personal and professional support
Financial Security
- 401(k) Retirement Savings Plan with company match
- Paid Time Off (PTO) that accrues immediately from day one
- Paid Holidays for a healthy work-life balance
- Access to DailyPay, enabling you to access up to 100% of your earned wages on a daily basis
- Tuition Reimbursement up to $5,250 per year for ANY field of study
- Tuition Discounts through exclusive partnerships with the University of Cincinnati, University of Toledo, and Hondros College
- Employee-Sponsored Crisis Fund available for those facing unforeseen challenges
- Legal & Identity Theft Protection
Growth & Development
- University Partnerships with University of Cincinnati, University of Toledo, and Hondros College for exclusive tuition discounts
- Multiple Partner Discounts available for various products and services through Access Perks
- Access to 1,000s of hours of personal and professional development material through RightNow Media @ Work
*Some benefits, including PTO and tuition reimbursement, are based on hours worked.
Apply today and begin a meaningful career as a Director of Managed Care at Otterbein!