Director - Payor Contracting Job at Advocate Health Care (Charlotte)

Associate Director Managed Care Contracting

Responsible for managed care portfolio performance for assigned payors. Implemen...

Location

United States , Charlotte

Salary:

51.05 - 76.60 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Bachelor's degree required
Master's degree preferred (MBA or MHA preferred)
Minimum of 5 years experience as a contract negotiator with a large provider or 7 years small provider or payor experience as a contract negotiator with a Bachelor's degree
OR Minimum of 3 years experience as a contract negotiator with a large provider or 5 years small provider or payor experience as a contract negotiator with a Master's degree

Job Responsibility

Assists in the development and implementation of the System's strategies and objectives related to managed care contracting for assigned Managed Care Organizations
Responsible for rate and language negotiation of assigned payor agreements
Assists in negotiations and maintenance of collaborative/value based managed care agreements including but not limited to provider tiering and performance reporting
Monitors, regularly reviews and report financial and operational performance of assigned payor contracts versus expectations
Gathers and analyzes data and apply methodologies
Creates and implements managed care contracting policies and procedures to maximize System performance in managed care relationships
Provides System with accurate and current managed care market intelligence

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Medical Director of Revenue Integrity

The Physician Advisor is a key member of the healthcare organization’s leadershi...

Location

United States , Cheyenne

Salary:

Not provided

Cheyenne Regional Medical Center

Expiration Date

Until further notice

Requirements

Hold and maintain or able to obtain an unrestricted medical license in the state of Wyoming
Possess or acquires a solid foundation, knowledge, and/or experience in the areas of utilization management, quality improvement, and patient safety
Familiarity with InterQual and MCG is preferred
Strong understanding of Medicare Two Midnight Rules
Member of the American College of Physician Advisors (ACPA)
Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) or ACPA is required within 6 months of hire
Ability to build rapport with medical staff and hospital leadership to obtain the buy-in and collaboration necessary to achieve desired outcomes
Prefer Internal Medicine specialist with a background in Hospital Medicine
Maintain active medical practice in their specialty (Can accommodate clinical time up to 0.15 FTE in the specialty (depending on availability))
Demonstrates behavior that supports the organization’s mission

Job Responsibility

Provide functional leadership for the revenue integrity team Including CDI, Coding and Utilization Review
Responsible for oversight revenue integrity optimization
Lead value-based care initiatives for the organization
Chairs the Utilization Management Team
Review medical records of patients identified by case managers or as requested by the healthcare team including physicians to perform quality and utilization oversight
Perform medical necessity reviews including initial level of care, secondary reviews, and continued stay reviews
Conduct Peer to Peer discussion with Payor Medical Directors when requested
Provide regular feedback to physicians and all other stake holders regarding level of care, length of stay, and potential quality issues
Provide necessary clinical education to UR Case Managers regarding clinical criteria and appropriate use of screening tools
Educates individual hospital staff physicians about ICD-10 and DRG coding guidelines (e.g., co-morbid conditions, outpatient vs. inpatient) and clinical terminology to improve their understanding of severity, acuity, risk of mortality, and DRG assignments on their individual patient records

What we offer

403(b) with 4% employer match
ANCC Magnet Hospital
$10,000 relocation bonus
$3,500 in CMEs
216 hours of PTO
Robust Benefits Package

Managed Care Manager - Contracts

Corporate level manager responsible for deploying and contributing to strategic ...

Location

Hollywood

Salary:

Not provided

Memorial Healthcare System

Expiration Date

Until further notice

Requirements

Bachelors (Required)
5 years contracting experience with 3 years contracting for hospital, professional services, ancillary facilities or specialty networks

Job Responsibility

Execute and manage legal, financial and operational contract language negotiations in concert with the Director of Managed Care
Contribute and coordinate negotiations of ancillary services in concert with the Director of Managed Care
Enhance, estimate and preserve net revenues and build market share
Escalate, monitor and manage operational issues from Managed Care Revenue Optimization, Accounts Receivable Management or Joint Operations
Address all single-case negotiations with non-contracted payors
Respond to insurance industry activities, healthcare reform, payer strategies, emerging market demands and legislative considerations

Fulltime

Sr. Director of Revenue Accounting

We are looking for an experienced and results-driven Sr. Director of Revenue to ...

Location

United States , San Francisco

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum 10+ years of revenue accounting experience in biotech/pharmaceutical industry
Expertise in gross-to-net accounting, including payor contracts, rebates, and chargebacks
Proven leadership experience, including managing cross-functional teams and complex financial processes
Excellent analytical and problem-solving skills, with a focus on accuracy and attention to detail
Proficiency in financial forecasting, budgeting, and reporting tools

Job Responsibility

Lead and manage the revenue accounting processes, including product revenue, gross-to-net accounting, receivables, royalties, rebates, and chargebacks
Oversee the monthly and quarterly financial close processes to ensure accurate and timely reporting of revenue-related accounts
Review and approve revenue entries, reconciliations, and allocation of product sales by site and region
Develop and distribute monthly revenue flash reports and provide ad-hoc financial analysis as needed
Collaborate with cross-functional teams, such as Market Access and Commercial Analytics, to ensure data accuracy and support business insights
Establish and lead structured cross-functional reviews of gross-to-net estimates, partnering with departments to improve forecasting accuracy
Provide subject matter expertise on payor contract terms, ensuring proper interpretation and reflection in financial assumptions
Support the launch of new products by offering financial guidance and contributing to forecasting and budgeting efforts
Serve as a key member of the finance to support strategic decisions

What we offer

Medical
Vision
Dental
Life and disability insurance
401(k) plan

Fulltime

Senior Clinical Rehab Liaison

Senior Clinical Rehab Liaison Career Opportunity. Appreciated for your Skills - ...

Location

United States , Wildwood

Salary:

Not provided

Encompass Health

Expiration Date

Until further notice

Requirements

Current driver's license in state employed and acceptable driving record according to company policy
Current State Professional license
Minimum 3-5 years of experience as a liaison or licensed clinician preferred

Job Responsibility

Provides in-services and professional presentations
Assists Business Development Director in the referral-to-admit process and department tasks
Develops call plans and strategies to drive volume using the Referral Development System (RDS)
Uses market analysis data in individual territory identifying new business opportunities
Utilizes CRM for creating, tracking, and monitoring liaison territory referrals and activities
Educates community, referral sources and physicians on hospital programs and services
Conducts routine competitor analysis
Responds to and addresses potential admission barriers and follows up on admission variables
Works with the Regional Director of Managed Care to identify commercial contracting opportunities
Works with the Admissions Liaison to ensure appropriate contract rates negotiated at admission

What we offer

Affordable medical, dental, and vision plans for both full-time and part-time employees and their families
Generous paid time off that accrues over time
Opportunities for tuition reimbursement and continuous education
Company-matching 401(k) and employee stock purchase plans
Flexible spending and health savings accounts

Fulltime

Director Managed Care

The Director Managed Care is responsible for enhancing and maintaining managed c...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Bachelor's Degree required

Job Responsibility

Leads and/or assists in the strategic planning, analysis and negotiation of System and region specific managed care contracts on an as-needed basis under the guidance of the System Director or the Corporate VP Managed Care department
Responsible as the managed care subject matter expert to the assigned region
Develops and maintains relationships with staff of managed care plans in the regions or corporate level of the organizations
Directs staff in investigating and resolving managed care reimbursement issues identified by PFS and/or payers, including root cause issues including fee schedule and reimbursement loading of contracts
Directs appropriate managed care related education and training including roll out of new Payor contracts and new products (e.g.. Marketplace-Health Insurance Exchange products)
Assures that new contracts are rolled out in a timely, accurate manner
Assists in Payor/plan dispute resolution projects as appropriate
Negotiates one-time Letters of Agreement and/or template for Regional use
Responsible for distribution of managed care related information to hospitals, physician group leadership, ancillary leadership and regions
Participates in operational meetings with applicable payers as part of the Corporate Managed Care department

Fulltime

Research Director

The Research Director will be responsible for leading the execution of Equip’s r...

Location

United States

Salary:

150000.00 - 175000.00 USD / Year

Equip Health

Expiration Date

Until further notice

Requirements

PhD/PsyD in clinical psychology or related fields
8+ years experience researching and evaluating behavioral health outcomes in the eating disorder field
Proven track record leading research teams and driving strategic research roadmaps
Proven experience working with both Randomized Controlled Trial (RCT) data and Real-World Data (RWD) sources (e.g., claims, EHR, or disease registries) to generate robust clinical insights
Experience successfully aligning research with business objectives
Excellent communication and relationship-building skills with both scientific and non-scientific audiences
Demonstrated ability to multi-task and prioritize in a dynamic environment
Comfortable with ambiguity and changing priorities

Job Responsibility

Identify and establish research priorities to enhance Equip’s visibility and thought leadership in the industry
Collaborate with cross-functional leaders to align research priorities with broader organizational goals and strategy
Develop and manage a research roadmap aligned with organizational goals and external market needs
Oversee the full research lifecycle, from concept development and study design through analysis and publication
Collaborate with Clinical Outcomes & Clinical Quality teams to ensure that research efforts directly enhance outcomes measurement and overall patient outcomes
Partner with Commercial teams to ensure Equip’s research supports and furthers payor contracting and patient referral efforts
Elevate Equip’s scientific brand by contributing to thought leadership, evidence generation, and presence in the academic and clinical communities
Foster and maintain effective collaborative relationships and strategic partnerships with research universities
Maintain awareness of industry trends, peer-reviewed literature, and competitive research
Perform other duties as assigned

What we offer

Offers Bonus

Fulltime

Managed Care Senior Manager

Corporate level manager responsible for deploying and contributing to strategic ...

Location

United States , Fort Lauderdale

Salary:

Not provided

Memorial Healthcare System

Expiration Date

Until further notice

Requirements

Bachelors
Five (5) years contracting experience with three (3) years contracting for hospital, professional services, ancillary facilities or specialty networks

Job Responsibility

Execute, contribute and manage complex legal, financial and operational contract language negotiations in concert with the Director of Managed Care or independently as applicable to the negotiation
Execute contracting strategies for all service lines in Memorial Hospitals, MHS employed physicians, transplant programs, and ancillary services of the fully integrated healthcare delivery system and its joint owned or joint ventured entities for fee for service and value based arrangements
Direct and analyze financial performance, reports and models, quality metrics and cost savings for negotiations with national and regional payors
Plan and monitor activities of staff and team members including hiring, orienting, training, mentoring, continuing education, evaluating, coaching and disciplinary actions
Enhance, estimate and preserve net revenues
Assure financial viability of contracts through financial analysis and forecasting in conjunction with Financial Analyst(s), contract negotiations and issue resolution
Execute strategies and guides operations to protect and build market share
Interface with managed care plans on claim reconciliations, trended issues and operational projects
Determine root cause and seek resolution
Evaluate payor assessments of overpayments and effectively dispute or resolve for settlement

Fulltime

Director - Payor Contracting

Advocate Health Care

Location:
United States , Charlotte

Category:
Finance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
February 04, 2026

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