Director Managed Care

Summary

Under the general supervision of the CFO, the Managed Care Director will provide strategic leadership and expert oversight for all aspects of MCW's payer relations and contracting, ensuring optimal financial performance and sustainable partnerships with health plans. The Director will develop and implement new and established contracts for professional services on behalf of the MCW Medical College Physicians adult specialty care practice. This role will lead negotiations with payers to include payment terms based on multiple reimbursement models, including fee-for-service payment terms, value-based payments, and gain/risk sharing agreements. The Director will be responsible for negotiating contract language that aligns with all State and Federal laws and regulations, and organizational policies. This position will collaborate closely with ACO/CIN partners to ensure compliant and equitable reimbursement under value-based care contracts and programs.

Hybrid role: Primarily remote with occasional onsite presence.

Primary Responsibilities

• Manage relationships with payers, lead negotiations, preparation, documentation, and implementation of new and established managed care contracts for professional services on behalf of the MCW Medical College Physicians adult specialty care practice.

• Develop standards for contracts, including payment terms, general language and provisions based on strategy discussions, senior management input, and organizational needs.

• Evaluate rate proposals, changes to reimbursement methodologies, and conduct related analyses to ensure continued financial viability of the contract.

• In collaboration with MCW and MCP Senior Leadership, develop and execute communication plans and payer negotiation outlines related to payer relationships, negotiations, organizational contractual obligations, and developments in the managed care marketplace.

• Stays current with emerging payer trends, new reimbursement methodologies, state specific regulatory issues, plan benefits, payer activity, products, and delivery channels, including health insurance exchanges, market competition, etc.

• Ensure contracts and proposals are properly entered into organizational database to measure, track, and monitor utilization and financial performance of managed care contracts.

• Negotiate single case agreements to capture financial reimbursement from non-contracted payers and entities.

• Serves as primary organizational contact during payer contract negotiations.

• Assists CPS and internal customers with resolution of complex payer issues. Participate in JOC and leadership meetings with third party payers to address contractual payment issues and trends.

• Communicates and provides tools for contractual terms to other departments whose functions are necessary to the development, implementation, and management of the provider arrangements.

Knowledge - Skills - Abilities

• Possess strong analytical and negotiation skills

• Comprehensive understanding of healthcare reimbursement methodologies, managed care models, and regulatory requirements.

• Proven leadership experience in payer contracting and relations within a complex healthcare environment.

• Advanced proficiency in Microsoft Office products; ability to create and interpret complex reports and data sets.

• Strong analytical and problem-solving skills, with the ability to identify trends, investigate issues, and develop actionable solutions.

• Excellent written and verbal communication skills, including the ability to present complex information clearly to diverse audiences.

• Effective interpersonal and listening skills, with a professional and confident demeanor in interactions with physicians, staff, and leadership.

• Ability to manage multiple tasks and priorities simultaneously, demonstrating flexibility and adaptability in a dynamic healthcare environment.

• Ability to provide education and training to physicians, department administrators, and health system leaders on payer contracting and reimbursement strategies.

• Attention to detail and accuracy, especially in reviewing financial data and managed care contracts.

• Patience and diplomacy in resolving sensitive or complex issues across departments and with external stakeholders.

• Capacity to lead and participate in improvement initiatives, policy development, and special projects related to reimbursement and payer contracting.

Qualifications

Appropriate experience may be substituted for education on an equivalent basis

Minimum Required Education: Bachelor's degree in business, finance, healthcare administration, or related field.

Minimum Required Experience: 8 years of experience in healthcare payer contracting and negotiating on behalf of a medical group, health system, or payer.

Preferred Education:Master's degree in business, finance, or healthcare administration.

Preferred Experience:10 years of experience, including leading contract negotiations on behalf of a medical group or health system; strong knowledge of local and regional healthcare and payer markets.

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Physical Requirements

Work requires occasionally lifting moderate weight materials, standing, or walking continuously.

Work Environment

Occasional exposure to dust, noise, temperature changes, or contact with water or other liquids. Work is performed in an environmentally controlled environment.

Sensory Acuity

Ability to detect and translate speech or other communication required. May occasionally require the ability to distinguish colors and perceive relative distances between objects.

• Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental. Along with Flexible Spending options

• 403B Retirement Package

• Competitive Vacation and Paid Holidays offered

• Tuition Reimbursement

• Paid Parental Leave

• Employee & Family Assistance Program (EFAP)

• Pet Insurance

• On campus Fitness Facility, offering onsite classes

• Additional discounted rates on items such as: Select cell phone plans, local fitness facilities, Milwaukee recreation and entertainment etc.

For a brief overview of our benefits see: Benefits Overview

For a full list of positions see: MCW Careers

At MCW all of our endeavors, from our internal operations to our interactions with our partners, are driven by our shared organizational values: Caring - Collaborative - Curiosity - Inclusive - Integrity - Respect. We are committed to fostering an inclusive environment that values diversity in backgrounds, experiences, and perspectives through merit-based processes and in alignment with all applicable laws. We believe that embracing human differences is critical to realize our vision of a healthier world, and we recognize that a healthy and thriving community starts from within. Our values define who we are, what we stand for and how we conduct ourselves at MCW. If you believe in embracing individuality and working together according to these principles to improve health for all, then MCW is the place for you. For more information, please visit our institutional website.

The Medical College of Wisconsin (MCW) is an Equal Opportunity Employer. We are committed to fostering an inclusive community of outstanding faculty, staff, and students, as well as ensuring equal educational opportunity, employment, and access to services, programs, and activities, without regard to an individual's race, color, national origin, religion, age, disability, sex, gender identity/expression, sexual orientation, marital status, pregnancy, predisposing genetic characteristic, or military status. Employees, students, applicants or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.