Senior Director, Managed Care Contracting

🔥 15 hours ago

🌽 Illinois – Remote

🌽 Illinois – Remote

⏰ Full Time

🟠 Senior

👔 Director

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Lumexa Imaging

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2018

🏥 Healthcare

🤝 B2B

Healthcare • B2B

Lumexa Imaging is a national outpatient diagnostic imaging company building partnerships with health systems to expand access to advanced medical imaging. It operates 185+ outpatient imaging centers across 13 states (including 85+ centers run as joint ventures with health systems), provides centralized scheduling, subspecialized radiologist interpretations (including teleradiology through its Connexia offering), and leverages AI and state-of-the-art equipment to improve clinical quality and operational efficiency. Lumexa focuses on patient experience, convenient outpatient care that can be lower-cost than hospital outpatient departments, and collaborative joint ventures with health systems.

📋 Description

• Establish, build, and maintain positive working relationships with payer representatives and leadership within assigned geographies and/or projects. • Collaborate with joint venture managed care and other colleagues to accomplish joint managed care contracting and operational targets. • Lead negotiation and execution of contracts with managed care payers and other third parties. • Collaborate with internal and external legal counsel to review, evaluate, and document payer contract language against department and regulatory standards. • Perform ad hoc contract language review and analysis. • Serve as an internal resource for payer contract language questions and requests. • Work with financial analysts and department/company team members to prepare data and analysis for negotiations and trending claim or operational issues. • Guide department team members in planning contract negotiations and renewals, including historical performance assessment and opportunity identification. • Ensure completion of contracting for acquired or new facilities and practices. • Manage resolution of contract-related claims and operational issues with internal and external customers, Managed Care Operations, and revenue cycle teams. • Ensure new and revised contract terms are communicated to internal customers. • Develop and maintain department tracking documents. • Manage special projects and perform other assigned duties.

🎯 Requirements

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, Law, or a related field required. • Master's degree in Business Administration (MBA), Healthcare Administration (MHA), Public Health (MPH), or Juris Doctor (JD) preferred. • Minimum of 10 years of progressively responsible experience in managed care contracting, payer relations, or healthcare reimbursement, including extensive experience negotiating complex payer agreements. • Minimum of 5 years of leadership experience with responsibility for managing teams, projects, and organizational initiatives. • Experience working with hospitals, physician organizations, integrated delivery systems, or large multi-specialty healthcare organizations preferred. • Demonstrated success developing and implementing contracting strategies that improve reimbursement, operational performance, and organizational outcomes. • Expert knowledge of managed care contracting principles, payer reimbursement methodologies, and healthcare payment models, including fee-for-service, value-based reimbursement, and alternative payment arrangements. • Comprehensive understanding of commercial, Medicare Advantage, Medicaid managed care, and other third-party payer contracting practices. • Strong knowledge of healthcare regulatory requirements affecting managed care contracting, reimbursement, and compliance. • Advanced contract negotiation, drafting, interpretation, and contract language analysis skills. • Exceptional financial and analytical skills with the ability to evaluate reimbursement methodologies, identify trends, and develop data-driven negotiation strategies. • Demonstrated ability to lead complex negotiations and influence internal and external stakeholders to achieve favorable outcomes. • Strong strategic planning, project management, and organizational skills with the ability to manage multiple priorities and deadlines. • Excellent written, verbal, and presentation communication skills. • Proven ability to build collaborative relationships across executive leadership, operations, finance, legal, revenue cycle, and clinical teams. • Strong leadership, coaching, and team development skills with experience fostering a high-performing, collaborative work environment. • Ability to exercise sound judgment, maintain confidentiality, and make informed decisions in complex or sensitive situations. • Proficiency with Microsoft Office applications, contract management systems, and healthcare financial and claims reporting tools.