Director of Managed Care

We are seeking a strategic Fractional Director of Managed Care to lead the optimization and expansion of our payer contract portfolio. As our organization continues to acquire and integrate specialized clinical practices, this role will be pivotal in ensuring our services—specifically Medical Nutrition Therapy (MNT)—are appropriately valued and credentialed across major national and regional insurance panels.

The ideal candidate has a deep rolodex within the "Provider Relations" departments of major payers (e.g., BCBS, UnitedHealthcare, Cigna, Aetna) and a proven track record of negotiating favorable rate increases and carve-outs for outpatient specialty services.

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Key Responsibilities

• Contract Negotiation & Portfolio Management: Lead the end-to-end negotiation process for new and existing payer contracts. Focus on moving beyond "standard" fee schedules to secure rates that reflect the clinical complexity of our specialty services.
• Acquisition Integration: Oversee the transition of payer contracts for newly acquired clinics. Determine the most efficient path for revenue continuity (e.g., "tagging on" to master group contracts vs. maintaining legacy individual contracts).
• Payer Relations & Strategy: Act as the primary liaison between our organization and insurance payers. Troubleshoot systemic reimbursement issues and stay ahead of changes in payer policies that impact MNT and clinical diagnostics.
• Credentialing Oversight: Provide strategic direction to our credentialing team to ensure new providers are "on-panel" and billing within 30–60 days. Explore and implement delegated credentialing agreements where applicable.

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Qualifications

• Experience: 10+ years in Managed Care, Payer Relations, or Contracting, specifically within a multi-site MSO or large physician group environment.
• Specialized Knowledge: Deep understanding of outpatient "carve-out" strategies is highly preferred.
• Network: An active network of contacts within the managed care industry to facilitate faster contract reviews and higher-level dispute resolution.

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How to Apply

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