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

Senior Clinical Rehab Liaison

Senior Clinical Rehab Liaison Career Opportunity. The Senior Clinical Rehab Liai...

Location

United States , Braintree

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
Marketing experience in a healthcare environment preferred
Familiarity with acute hospital, rehab hospitals, and local healthcare market 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

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

Account Executive, Market Intelligence (Payer)

Arcadia is the only healthcare data and software company dedicated to healthcare...

Location

Salary:

Not provided

The Muse

Expiration Date

Until further notice

Requirements

Bachelor’s degree and/or equivalent experience in business, healthcare administration, engineering, or a related discipline
A minimum of 5 years’ experience with a demonstrated track record of accomplishments in provider tech sales and business expansion
Within the Payer space, have a broad network of relationships Commercial, Regional, Health Plans and well known in the payor community. Experience consistently securing multi-year, 6-7 figure contracts with Provider organizations
Excellent presentation, written and verbal communication skills
Must be able to build and maintain strong relationships with C-level information technology executives, physicians, executives, leaders and staff at health plans, health systems, and healthcare provider groups
Proven results running long sales cycles (6-18 months) in enterprise settings
A hunter’s mentality with experience owning the end to end sales cycle from prospecting to closed business
Excellent communicator with the ability to persuasively articulate competitive advantages of Arcadia’s research data solutions
Strong knowledge base and stays abreast of major healthcare issues and trends in data analytics and value-based care
Must be able to work within Arcadia’s sales process to manage a pipeline of qualified sales opportunities across an assigned market and accurately project total contract value, revenue spread, and close dates for those opportunities

Job Responsibility

Generating new business opportunities by identifying, engaging, and closing new accounts in the Payor Healthcare Market (Commercial and Public Payors) with national and regional reach
Own the end-to-end sales cycle from prospecting to close of business
Conduct research to expand prospect list using MMIT, LinkedIn Sales Navigator, and other methods
Identify and develop leads and opportunities from multiple sources including prospect lists, discovery, and individual research
Build and cultivate prospect relationships by initiating communications and conducting follow-up qualification to move opportunities into the sales funnel
Perform thorough needs assessment and identify prospects pain points to determine how Arcadia’s solutions address those needs
Own and drive contract creation, legal review, and signature process with internal operations and key client executives
Identify and assist in resolving challenges that could prevent account retention, expansion, and referrals
Build relationships with C-level and purchasing executives at key prospects in support of sales and growth activities
Collaborate effectively with internal stakeholders from Product Management, Sales Operations, Operations and Finance throughout the course of each deal

What we offer

Pet Insurance
Health Insurance
Dental Insurance
Vision Insurance
FSA
HSA
HSA With Employer Contribution
Life Insurance
Short-Term Disability
Long-Term Disability

New

Bpaas sales executive

The BPO Sales Executive role at NTT DATA requires over 15 years of experience in...

Location

United Kingdom , London

Salary:

Not provided

NTT DATA

Expiration Date

Until further notice

Requirements

15+ years of experience in BPO / Business Process Services sales with a deep understanding of transformative outsourcing models
Demonstrated success having sold large, complex, global BPO deals (>$20M TCV)
Industry experience selling Transformative Customer Experience/ Customer Service and Industry Specific Core value chain deals
Strong financial acumen and ability to structure complex deal constructs
Exceptional executive presence, communication, and relationship-building skills
Experience working within or selling to Fortune 1000 clients

Job Responsibility

Market-maker who originates deals proactively
Subject Matter Expert in one or more of the following industries
Banking & Financial Services, Fintech, Insurance (P&C, L&A), Manufacturing/ Retail/ Consumer, Travel & Hospitality, Hi-tech, Energy & Utilities, Telecom, Healthcare (Payor, Provider) & Life Sciences
Utilize a consultative approach to understand the unique challenges, dynamics, constraints and goals of the prospective organization and the key stakeholders and be able to develop a customized transformative BPO/ BPaaS proposition
Lead the end-to-end sales cycle, (collaborating with solution architects, pricing teams, legal, operations, among others) to structure competitive multi-million-dollar ACV (annual contract value) BPO deals, from initial prospect engagement through contract negotiation and closure
Develop and execute a strategic go-to-market plan to create market awareness and demand in collaboration with Managing Director, Business Unit Leaders, business unit salespeople and client executives, industry teams, and alliance partners, advisor and analyst relations, and marketing
Build strong executive-level relationships with prospective decision makers and stakeholder influencers, including COOs, CIOs, CFOs, and Heads of Operations
Stay current on industry and AI/ technology trends, competitive positioning, and emerging technologies relevant to BPO and digital operations
Serve as a thought leader in the market and contribute to brand elevation via participation in industry forums, panels, and client advisory boards

What we offer

We offer a range of tailored benefits that support your physical, emotional, and financial wellbeing
Our Learning and Development team ensure that there are continuous growth and development opportunities for our people
We also offer the opportunity to have flexible work options

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

Looking for more opportunities? Search for other job offers that match your skills and interests.

Similar Jobs for Director - Payor Contracting