Director of Managed Care and Contracting

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🔥 0 minutes ago

🥔 Idaho, Oregon, +2 more states – Remote

🥔 Idaho – Remote 🌲 Oregon – Remote 🤠 Texas – Remote ☕ Washington – Remote

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 10%

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Performance Home Medical

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1995

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

Performance Home Medical is a Pacific Northwest home medical equipment and services provider specializing in sleep therapy, home oxygen, ventilation, respiratory care, and diabetic supply management. The company combines clinical expertise with retail and online sales (Performance CPAP Express), supply replenishment, and multi-location patient support to help individuals start and manage therapy at home.

📋 Description

• Lead the negotiation, execution, and management of managed care contracts with commercial, Medicare Advantage, Medicaid, and other third-party payors • Develop and maintain relationships with payor representatives • Serve as the primary point of contact for payor escalations, audits, and contract renewals • Monitor contract performance, reimbursement trends, and payor policy changes • Champion patient continuity of care during transitions, acquisitions, or market changes • Collaborate with clinical, operations, and finance teams • Identify and develop new payor relationships to expand network participation and market access • Analyze reimbursement data, utilization trends, and payor performance metrics • Prepare and present contract proposals, financial models, and managed care reports to senior leadership • Stay current on regulatory changes, reimbursement methodologies, and managed care best practices • Provide guidance and oversight to managed care staff • Mentor team members and support professional development • Build and maintain cross-departmental relationships

🎯 Requirements

• Bachelor’s degree in healthcare administration, business, or a related field required; advanced degree preferred • 7+ years of progressive experience in managed care contracting and payor relationship management • Prior experience in respiratory therapy, home medical equipment (HME), or related healthcare services strongly preferred • Demonstrated success negotiating complex managed care agreements with commercial and government payors • Deep understanding of payor reimbursement methodologies, fee schedule structures, and managed care regulatory frameworks • Exceptional negotiation skills • Strong analytical abilities and proficiency in interpreting data and translating insights into actionable strategy • Excellent written and verbal communication skills • Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, SharePoint) • Ability to manage multiple priorities and competing deadlines • Travel up to 50% within assigned region/territory as needed • Valid state driver’s license in state of residence; must meet Motor Vehicle policy requirements • Reliable transportation required

🏖️ Benefits

• Full-time employment • Fully remote position • Travel opportunities within assigned region/territory (up to 50%)