Verified Job
Healthcare
Director, Managed Care Contracting (Up to $220k plus bonus)
Healthcare
#803964
Remote / WFH
FOCUSPOINT
Job Description
Job highlights
Identified by Google from the original job post
Qualifications
Serve as an expert on payor contract terms, reimbursement methodologies, payor policies, CMS coverage requirements, authorization processes, denial trends, managed care operations, and contract administration
Minimum 7 years of recent experience in hospital, medical, or healthcare insurance environments with direct payer contracting responsibilities in an acute‑care setting
Demonstrated expertise in negotiating and managing payer contracts, reimbursement methodologies, and payor analytics
Advanced Excel skills, including modeling and complex formulas
Experience with hospital billing systems and financial reporting tools
Strong communication, analytical, and problem‑solving skills
Master’s degree in healthcare economics, healthcare policy, or finance
10+ years progressive hospital payer contracting experience
Prior experience supervising payer contracting or Revenue Integrity staff
Interested candidates should reach out to FocusPoint’s recruitment team with any questions
Benefits
Compensation: $130k to $220k plus bonus
FocusPoint – Confidential Healthcare Client Compensation: $130k–$220k + bonus opportunity + full benefits Location: Greater Los Angeles, California (onsite)
Mission‑driven healthcare environment with strong executive support
Competitive compensation, bonus opportunity, and comprehensive benefits
Responsibilities
This is a high‑impact leadership role responsible for advancing reimbursement outcomes, strengthening payor relationships, and driving financial sustainability across a complex acute‑care environment
The Director of Managed Care Contracting provides strategic leadership for payor contracting, reimbursement performance, and Revenue Integrity operations
This leader oversees contract strategy, negotiations, renewals, implementation, analytics, and performance management across commercial, government, and value‑based arrangements
The role partners closely with executive leadership to evaluate payor proposals, reimbursement methodologies, operational requirements, and financial impact
Managed Care Contracting & Payor Strategy
Lead the full lifecycle of managed care contracting, including negotiation, renewal, execution, implementation, and administration of fee‑for‑service, capitation, value‑based, bundled service, and LOA arrangements
Evaluate payor proposals, reimbursement methodologies, contract terms, operational requirements, and financial impact
Direct contract language review and amendment to mitigate reimbursement exposure, authorization delays, policy changes, denial trends, underpayments, and compliance risks
Drive strategic direction for commercial, HMO/PPO, Medicare Advantage, Medi‑Cal/Medicaid, and other payor arrangements
Revenue Integrity, Reimbursement & Contract Performance
Provide strategic leadership for Revenue Integrity functions, ensuring accurate reimbursement, compliance with contract terms, and effective underpayment resolution
Direct financial, operational, payor, and denial analytics to evaluate trends, revenue impact, claims activity, and opportunities for improvement
Lead disciplined contract performance reviews with recommendations for renewal, expansion, modification, termination, or escalation
Oversee executive dashboards that convert claims, denials, reimbursement trends, and payor behavior into actionable insights
Denials Analytics, Escalation & Prevention
Lead Denials Analytics across hospital and ambulatory settings, including appeals strategy, payor escalations, and Provider Relations coordination
Serve as senior escalation point for complex payor, contract, reimbursement, authorization, underpayment, and denial matters
Drive cross‑functional root‑cause analysis with Patient Access, UM, Case Management, CDI, HIM, ambulatory leadership, physicians, Finance, and Revenue Cycle
Advance organization‑wide denial prevention strategies aligned with contract terms, payor requirements, documentation standards, and billing workflows
Contract Operationalization & Cross‑Functional Leadership
Oversee operational implementation of managed care contracts, ensuring accurate rate setup, authorization alignment, payor policy communication, workflow readiness, and post‑implementation monitoring
Lead payor relations and cross‑functional engagement through governance meetings, joint operating sessions, issue‑resolution forums, and ongoing communication
Process Improvement, Systems & Operational Excellence
Lead workflow modernization, automation, and technology‑enabled process improvement initiatives
Establish intake, triage, tracking, escalation, and accountability structures for payor issues, reimbursement disputes, authorization barriers, LOA requests, denial trends, and underpayments
Use continuous improvement methods, benchmarking, and analytics to drive measurable gains in managed care operations, Revenue Integrity, and contract performance
Opportunity to shape contract outcomes, reimbursement strategy, and Revenue Integrity operations
To ensure confidentiality and alignment with our client’s hiring process, all applications must be submitted through FocusPoint
Job description
Position: Director, Managed Care Contracting
Location: Greater Los Angeles, CA
Worksite: In office
Employment Type: Full Time
Compensation: $130k to $220k plus bonus
FocusPoint – Confidential Healthcare Client Compensation: $130k–$220k + bonus opportunity + full benefits Location: Greater Los Angeles, California (onsite)
Our client, a respected healthcare organization in the Greater Los Angeles region, is seeking an experienced Director of Managed Care Contracting to lead payor strategy, contract performance, and Revenue Integrity functions. This is a high‑impact leadership role responsible for advancing reimbursement outcomes, strengthening payor relationships, and driving financial sustainability across a complex acute‑care environment.
About the Role
The Director of Managed Care Contracting provides strategic leadership for payor contracting, reimbursement performance, and Revenue Integrity operations. This leader oversees contract strategy, negotiations, renewals, implementation, analytics, and performance management across commercial, government, and value‑based arrangements. The role partners closely with executive leadership to evaluate payor proposals, reimbursement methodologies, operational requirements, and financial impact.
Key Responsibilities
Managed Care Contracting & Payor Strategy
Lead the full lifecycle of managed care contracting, including negotiation, renewal, execution, implementation, and administration of fee‑for‑service, capitation, value‑based, bundled service, and LOA arrangements.
Evaluate payor proposals, reimbursement methodologies, contract terms, operational requirements, and financial impact.
Direct contract language review and amendment to mitigate reimbursement exposure, authorization delays, policy changes, denial trends, underpayments, and compliance risks.
Drive strategic direction for commercial, HMO/PPO, Medicare Advantage, Medi‑Cal/Medicaid, and other payor arrangements.
Revenue Integrity, Reimbursement & Contract Performance
Provide strategic leadership for Revenue Integrity functions, ensuring accurate reimbursement, compliance with contract terms, and effective underpayment resolution.
Direct financial, operational, payor, and denial analytics to evaluate trends, revenue impact, claims activity, and opportunities for improvement.
Lead disciplined contract performance reviews with recommendations for renewal, expansion, modification, termination, or escalation.
Oversee executive dashboards that convert claims, denials, reimbursement trends, and payor behavior into actionable insights.
Denials Analytics, Escalation & Prevention
Lead Denials Analytics across hospital and ambulatory settings, including appeals strategy, payor escalations, and Provider Relations coordination.
Serve as senior escalation point for complex payor, contract, reimbursement, authorization, underpayment, and denial matters.
Drive cross‑functional root‑cause analysis with Patient Access, UM, Case Management, CDI, HIM, ambulatory leadership, physicians, Finance, and Revenue Cycle.
Advance organization‑wide denial prevention strategies aligned with contract terms, payor requirements, documentation standards, and billing workflows.
Contract Operationalization & Cross‑Functional Leadership
Oversee operational implementation of managed care contracts, ensuring accurate rate setup, authorization alignment, payor policy communication, workflow readiness, and post‑implementation monitoring.
Lead payor relations and cross‑functional engagement through governance meetings, joint operating sessions, issue‑resolution forums, and ongoing communication.
Process Improvement, Systems & Operational Excellence
Lead workflow modernization, automation, and technology‑enabled process improvement initiatives.
Establish intake, triage, tracking, escalation, and accountability structures for payor issues, reimbursement disputes, authorization barriers, LOA requests, denial trends, and underpayments.
Use continuous improvement methods, benchmarking, and analytics to drive measurable gains in managed care operations, Revenue Integrity, and contract performance.
Subject Matter Expertise
Serve as an expert on payor contract terms, reimbursement methodologies, payor policies, CMS coverage requirements, authorization processes, denial trends, managed care operations, and contract administration.
Required Qualifications
Bachelor’s degree required (economics, business, finance, or healthcare preferred).
Minimum 7 years of recent experience in hospital, medical, or healthcare insurance environments with direct payer contracting responsibilities in an acute‑care setting.
Demonstrated expertise in negotiating and managing payer contracts, reimbursement methodologies, and payor analytics.
Advanced Excel skills, including modeling and complex formulas.
Experience with hospital billing systems and financial reporting tools.
Strong communication, analytical, and problem‑solving skills.
Preferred Qualifications
Master’s degree in healthcare economics, healthcare policy, or finance.
10+ years progressive hospital payer contracting experience.
Prior experience supervising payer contracting or Revenue Integrity staff.
What Makes This Opportunity Attractive
High‑visibility leadership role influencing payor strategy and financial performance.
Opportunity to shape contract outcomes, reimbursement strategy, and Revenue Integrity operations.
Mission‑driven healthcare environment with strong executive support.
Competitive compensation, bonus opportunity, and comprehensive benefits.
Why Work with FocusPoint
As a trusted staffing partner to industry-leading companies, FocusPoint provides access to roles that align with your professional goals, and we advocate for your success throughout the recruitment process. Our team understands appropriate skillsets and takes a consultative approach ensuring that each match is grounded in both experience and fit.
How to Apply
To ensure confidentiality and alignment with our client’s hiring process, all applications must be submitted through FocusPoint. Please do not attempt to contact the client directly. Interested candidates should reach out to FocusPoint’s recruitment team with any questions.
About FocusPoint:
FocusPoint specializes in connecting top-tier professionals with exceptional opportunities in accounting, technology, healthcare, and leadership. We prioritize building meaningful connections, ensuring candidates find roles that align with their skills, goals, and passions.
Accounting, Technology and Leadership Staffing Agency
Identified by Google from the original job post
Qualifications
Serve as an expert on payor contract terms, reimbursement methodologies, payor policies, CMS coverage requirements, authorization processes, denial trends, managed care operations, and contract administration
Minimum 7 years of recent experience in hospital, medical, or healthcare insurance environments with direct payer contracting responsibilities in an acute‑care setting
Demonstrated expertise in negotiating and managing payer contracts, reimbursement methodologies, and payor analytics
Advanced Excel skills, including modeling and complex formulas
Experience with hospital billing systems and financial reporting tools
Strong communication, analytical, and problem‑solving skills
Master’s degree in healthcare economics, healthcare policy, or finance
10+ years progressive hospital payer contracting experience
Prior experience supervising payer contracting or Revenue Integrity staff
Interested candidates should reach out to FocusPoint’s recruitment team with any questions
Benefits
Compensation: $130k to $220k plus bonus
FocusPoint – Confidential Healthcare Client Compensation: $130k–$220k + bonus opportunity + full benefits Location: Greater Los Angeles, California (onsite)
Mission‑driven healthcare environment with strong executive support
Competitive compensation, bonus opportunity, and comprehensive benefits
Responsibilities
This is a high‑impact leadership role responsible for advancing reimbursement outcomes, strengthening payor relationships, and driving financial sustainability across a complex acute‑care environment
The Director of Managed Care Contracting provides strategic leadership for payor contracting, reimbursement performance, and Revenue Integrity operations
This leader oversees contract strategy, negotiations, renewals, implementation, analytics, and performance management across commercial, government, and value‑based arrangements
The role partners closely with executive leadership to evaluate payor proposals, reimbursement methodologies, operational requirements, and financial impact
Managed Care Contracting & Payor Strategy
Lead the full lifecycle of managed care contracting, including negotiation, renewal, execution, implementation, and administration of fee‑for‑service, capitation, value‑based, bundled service, and LOA arrangements
Evaluate payor proposals, reimbursement methodologies, contract terms, operational requirements, and financial impact
Direct contract language review and amendment to mitigate reimbursement exposure, authorization delays, policy changes, denial trends, underpayments, and compliance risks
Drive strategic direction for commercial, HMO/PPO, Medicare Advantage, Medi‑Cal/Medicaid, and other payor arrangements
Revenue Integrity, Reimbursement & Contract Performance
Provide strategic leadership for Revenue Integrity functions, ensuring accurate reimbursement, compliance with contract terms, and effective underpayment resolution
Direct financial, operational, payor, and denial analytics to evaluate trends, revenue impact, claims activity, and opportunities for improvement
Lead disciplined contract performance reviews with recommendations for renewal, expansion, modification, termination, or escalation
Oversee executive dashboards that convert claims, denials, reimbursement trends, and payor behavior into actionable insights
Denials Analytics, Escalation & Prevention
Lead Denials Analytics across hospital and ambulatory settings, including appeals strategy, payor escalations, and Provider Relations coordination
Serve as senior escalation point for complex payor, contract, reimbursement, authorization, underpayment, and denial matters
Drive cross‑functional root‑cause analysis with Patient Access, UM, Case Management, CDI, HIM, ambulatory leadership, physicians, Finance, and Revenue Cycle
Advance organization‑wide denial prevention strategies aligned with contract terms, payor requirements, documentation standards, and billing workflows
Contract Operationalization & Cross‑Functional Leadership
Oversee operational implementation of managed care contracts, ensuring accurate rate setup, authorization alignment, payor policy communication, workflow readiness, and post‑implementation monitoring
Lead payor relations and cross‑functional engagement through governance meetings, joint operating sessions, issue‑resolution forums, and ongoing communication
Process Improvement, Systems & Operational Excellence
Lead workflow modernization, automation, and technology‑enabled process improvement initiatives
Establish intake, triage, tracking, escalation, and accountability structures for payor issues, reimbursement disputes, authorization barriers, LOA requests, denial trends, and underpayments
Use continuous improvement methods, benchmarking, and analytics to drive measurable gains in managed care operations, Revenue Integrity, and contract performance
Opportunity to shape contract outcomes, reimbursement strategy, and Revenue Integrity operations
To ensure confidentiality and alignment with our client’s hiring process, all applications must be submitted through FocusPoint
Job description
Position: Director, Managed Care Contracting
Location: Greater Los Angeles, CA
Worksite: In office
Employment Type: Full Time
Compensation: $130k to $220k plus bonus
FocusPoint – Confidential Healthcare Client Compensation: $130k–$220k + bonus opportunity + full benefits Location: Greater Los Angeles, California (onsite)
Our client, a respected healthcare organization in the Greater Los Angeles region, is seeking an experienced Director of Managed Care Contracting to lead payor strategy, contract performance, and Revenue Integrity functions. This is a high‑impact leadership role responsible for advancing reimbursement outcomes, strengthening payor relationships, and driving financial sustainability across a complex acute‑care environment.
About the Role
The Director of Managed Care Contracting provides strategic leadership for payor contracting, reimbursement performance, and Revenue Integrity operations. This leader oversees contract strategy, negotiations, renewals, implementation, analytics, and performance management across commercial, government, and value‑based arrangements. The role partners closely with executive leadership to evaluate payor proposals, reimbursement methodologies, operational requirements, and financial impact.
Key Responsibilities
Managed Care Contracting & Payor Strategy
Lead the full lifecycle of managed care contracting, including negotiation, renewal, execution, implementation, and administration of fee‑for‑service, capitation, value‑based, bundled service, and LOA arrangements.
Evaluate payor proposals, reimbursement methodologies, contract terms, operational requirements, and financial impact.
Direct contract language review and amendment to mitigate reimbursement exposure, authorization delays, policy changes, denial trends, underpayments, and compliance risks.
Drive strategic direction for commercial, HMO/PPO, Medicare Advantage, Medi‑Cal/Medicaid, and other payor arrangements.
Revenue Integrity, Reimbursement & Contract Performance
Provide strategic leadership for Revenue Integrity functions, ensuring accurate reimbursement, compliance with contract terms, and effective underpayment resolution.
Direct financial, operational, payor, and denial analytics to evaluate trends, revenue impact, claims activity, and opportunities for improvement.
Lead disciplined contract performance reviews with recommendations for renewal, expansion, modification, termination, or escalation.
Oversee executive dashboards that convert claims, denials, reimbursement trends, and payor behavior into actionable insights.
Denials Analytics, Escalation & Prevention
Lead Denials Analytics across hospital and ambulatory settings, including appeals strategy, payor escalations, and Provider Relations coordination.
Serve as senior escalation point for complex payor, contract, reimbursement, authorization, underpayment, and denial matters.
Drive cross‑functional root‑cause analysis with Patient Access, UM, Case Management, CDI, HIM, ambulatory leadership, physicians, Finance, and Revenue Cycle.
Advance organization‑wide denial prevention strategies aligned with contract terms, payor requirements, documentation standards, and billing workflows.
Contract Operationalization & Cross‑Functional Leadership
Oversee operational implementation of managed care contracts, ensuring accurate rate setup, authorization alignment, payor policy communication, workflow readiness, and post‑implementation monitoring.
Lead payor relations and cross‑functional engagement through governance meetings, joint operating sessions, issue‑resolution forums, and ongoing communication.
Process Improvement, Systems & Operational Excellence
Lead workflow modernization, automation, and technology‑enabled process improvement initiatives.
Establish intake, triage, tracking, escalation, and accountability structures for payor issues, reimbursement disputes, authorization barriers, LOA requests, denial trends, and underpayments.
Use continuous improvement methods, benchmarking, and analytics to drive measurable gains in managed care operations, Revenue Integrity, and contract performance.
Subject Matter Expertise
Serve as an expert on payor contract terms, reimbursement methodologies, payor policies, CMS coverage requirements, authorization processes, denial trends, managed care operations, and contract administration.
Required Qualifications
Bachelor’s degree required (economics, business, finance, or healthcare preferred).
Minimum 7 years of recent experience in hospital, medical, or healthcare insurance environments with direct payer contracting responsibilities in an acute‑care setting.
Demonstrated expertise in negotiating and managing payer contracts, reimbursement methodologies, and payor analytics.
Advanced Excel skills, including modeling and complex formulas.
Experience with hospital billing systems and financial reporting tools.
Strong communication, analytical, and problem‑solving skills.
Preferred Qualifications
Master’s degree in healthcare economics, healthcare policy, or finance.
10+ years progressive hospital payer contracting experience.
Prior experience supervising payer contracting or Revenue Integrity staff.
What Makes This Opportunity Attractive
High‑visibility leadership role influencing payor strategy and financial performance.
Opportunity to shape contract outcomes, reimbursement strategy, and Revenue Integrity operations.
Mission‑driven healthcare environment with strong executive support.
Competitive compensation, bonus opportunity, and comprehensive benefits.
Why Work with FocusPoint
As a trusted staffing partner to industry-leading companies, FocusPoint provides access to roles that align with your professional goals, and we advocate for your success throughout the recruitment process. Our team understands appropriate skillsets and takes a consultative approach ensuring that each match is grounded in both experience and fit.
How to Apply
To ensure confidentiality and alignment with our client’s hiring process, all applications must be submitted through FocusPoint. Please do not attempt to contact the client directly. Interested candidates should reach out to FocusPoint’s recruitment team with any questions.
About FocusPoint:
FocusPoint specializes in connecting top-tier professionals with exceptional opportunities in accounting, technology, healthcare, and leadership. We prioritize building meaningful connections, ensuring candidates find roles that align with their skills, goals, and passions.
Accounting, Technology and Leadership Staffing Agency
