Healthcare & Caregiving • Louisville, Kentucky, United States
Clayton Clinical
Position: Vice President of Managed Care
Job Type: Full-Time | Executive Leadership
Salary: Competitive Compensation Based on Experience
Clayton Clinical is seeking a dynamic, results-driven Vice President of Managed Care to lead our managed care contracting strategy, strengthen payer partnerships, and maximize revenue opportunities across our growing healthcare organization!
This is an exciting opportunity for an experienced healthcare executive who thrives in a fast-paced environment, excels at strategic negotiations, and is passionate about improving financial performance while supporting exceptional patient care.
As the Vice President of Managed Care, you will provide executive-level leadership and strategic oversight of managed care operations, payer contracting, provider network development, reimbursement optimization, and care coordination initiatives.
The ideal candidate will possess extensive experience in managed care contracting, strong financial and analytical expertise, and a proven ability to develop high-performing teams while building successful relationships with managed care organizations and healthcare partners.
Provide executive leadership and strategic direction for all managed care contracting, reimbursement, and payer relationship initiatives.
Develop and implement comprehensive managed care strategies that support organizational growth, financial sustainability, and operational excellence.
Establish and execute short- and long-term objectives to maximize managed care revenue and strengthen payer partnerships.
Collaborate with executive leadership, regional operations, clinical teams, and financial departments to align managed care initiatives with organizational goals.
Identify emerging healthcare trends, reimbursement changes, and market opportunities to maintain a competitive advantage.
Lead, mentor, and develop a high-performing managed care team while fostering accountability, collaboration, and continuous improvement.
Lead and oversee managed care contract negotiations, renewals, amendments, and strategic payer partnerships.
Develop and maintain strong relationships with managed care organizations, commercial insurance carriers, Medicare Advantage plans, Medicaid managed care organizations, and other healthcare payers.
Evaluate existing payer agreements and negotiate favorable reimbursement rates, contract terms, and payment structures.
Identify opportunities to expand payer networks, improve reimbursement methodologies, and increase organizational revenue.
Oversee provider network participation, facility credentialing, and payer enrollment requirements.
Serve as the organization's primary executive representative in managed care negotiations and strategic payer discussions.
Monitor payer performance, contract compliance, and reimbursement trends to ensure favorable financial outcomes.
Analyze managed care contract performance, reimbursement trends, payer mix, and financial data to identify revenue growth opportunities.
Develop strategies to improve reimbursement rates, reduce revenue leakage, and maximize contract profitability.
Partner with revenue cycle management and finance teams to address claims discrepancies, payment variances, denials, and underpayments.
Establish and monitor key performance indicators (KPIs) related to managed care revenue, contract performance, and payer relationships.
Conduct financial modeling and contract analyses to support negotiations and executive decision-making.
Identify and implement process improvements that enhance operational efficiency and financial performance.
Ensure accurate reimbursement and timely resolution of payer-related issues.
Provide strategic oversight of care coordination and managed care processes to promote high-quality, cost-effective healthcare delivery.
Collaborate with clinical leadership, case management teams, and facility administrators to improve care coordination and payer authorization processes.
Support initiatives that improve patient outcomes, reduce unnecessary costs, and enhance operational performance.
Develop and implement standardized managed care policies, procedures, and best practices across the organization.
Monitor regulatory changes and ensure compliance with applicable federal, state, and payer requirements.
Facilitate payer meetings, educational sessions, and strategic initiatives to strengthen organizational relationships and performance.
Participate in quality improvement initiatives and support organizational performance objectives.
Ensure managed care operations comply with applicable federal, state, and local regulations, contractual obligations, and organizational policies.
Maintain confidentiality of patient, employee, financial, and proprietary business information.
Collaborate with executive leadership on organizational expansion, acquisitions, market development, and strategic growth initiatives.
Represent Clayton Clinical professionally at industry conferences, payer meetings, and networking events.
Promote a culture of integrity, accountability, fiscal responsibility, and exceptional service.
Minimum of 5 years of progressive healthcare experience, including at least 3 years of managed care contracting, payer relations, or provider network development experience.
Demonstrated experience negotiating and managing managed care contracts and payer agreements.
Strong understanding of healthcare reimbursement methodologies, payer contracts, and revenue cycle operations.
Proven ability to analyze financial data, evaluate contract performance, and identify revenue optimization opportunities.
Strong leadership, strategic planning, negotiation, and relationship management skills.
Excellent written and verbal communication skills with the ability to interact effectively with executive leadership and external stakeholders.
Proficiency in Microsoft Office applications, financial reporting, and healthcare data analysis.
Ability to manage multiple priorities, lead cross-functional initiatives, and drive measurable results.
Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related field.
Master's degree in Healthcare Administration (MHA), Business Administration (MBA), or a related field.
Previous experience in a Director, Senior Director, Vice President, or comparable managed care leadership role.
Experience with skilled nursing facilities (SNFs), long-term care (LTC), post-acute care, or multi-facility healthcare organizations.
Extensive knowledge of Medicare Advantage, Medicaid managed care, and commercial payer contracting.
Experience managing payer relationships across multiple states and healthcare markets.
Demonstrated success improving reimbursement rates, negotiating favorable contracts, and driving revenue growth.
We believe exceptional leadership deserves exceptional rewards!
At Clayton Clinical, we recognize the value of experienced professionals who drive innovation, strengthen partnerships, and contribute to our continued success.
Competitive Executive Compensation: Salary commensurate with experience and qualifications.
Generous Paid Time Off (PTO): Enjoy time to recharge and maintain a healthy work-life balance.
401(k) Retirement Plan: Invest in your financial future.
Daily Pay Options: Flexible access to earned wages, where eligible.
Comprehensive Health Benefits: Medical, dental, and vision insurance options.
Disability Insurance: Additional protection and peace of mind.
Employee Wellness Programs: Resources designed to support your health and well-being.
Professional Development Opportunities: Continued education, leadership development, and career advancement.
Collaborative Executive Leadership Team: Work alongside dedicated healthcare professionals committed to excellence.
Growth & Innovation: Play a key role in shaping the future of a growing healthcare organization.
At Clayton Clinical, we are committed to providing exceptional healthcare services while building strong partnerships, supporting our employees, and creating meaningful opportunities for professional growth.
As our Vice President of Managed Care, you will have the opportunity to make a significant organizational impact by leading strategic payer negotiations, improving reimbursement performance, and supporting the continued growth of our healthcare network.
Clayton Clinical is proud to be an Equal Opportunity Employer committed to fostering a diverse, inclusive, and supportive workplace.
We provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, national origin, age, disability, veteran status, gender identity, or any other characteristic protected by applicable law.
We proudly encourage veterans, active-duty military personnel, reservists, National Guard members, and military spouses to apply.
#J-18808-Ljbffr