Director of Managed Care and Contracting (51476)

Job Details Job Location: Houston Head Office - Houston, TX 77070 Position Type: Full Time Job Category: Health Care Performance Home Medical has been a leader in providing quality products and services since 1995. At Performance Home Medical (PHM), our patients come first. We use the latest technology with compassionate clinical support to empower individuals in managing their conditions, helping them live longer, healthier, and more independent lives. We are seeking a dynamic, strategic, and results-driven Director of Managed Care and Contracting to lead and optimize our payer strategy and provider agreements. This key leadership role is responsible for developing, negotiating, and managing managed care contracts that align with our organization’s financial goals and patient care priorities. The ideal candidate will bring leadership qualities that resonate with the collaborative and mission-driven culture at Performance Home Medical, a leading provider of medical supplies. This remote position provides support across our markets in Washington, Oregon, Idaho, and Texas. POSITION SUMMARY: The Director of Managed Care and Contracting is responsible for developing, negotiating, and managing payor contracts to ensure optimal reimbursement and access for Performance Home Medical’s respiratory services. This role plays a critical part in shaping the company’s payor strategy, maintaining strong relationships with insurance partners, and ensuring compliance with regulatory and contractual obligations. Job Duties and Responsibilities include the following. Other duties may be assigned. Contract Strategy & Negotiation • Lead the development and execution of managed care strategies aligned with business goals. • Negotiate and manage contracts with commercial payors, Medicare Advantage, Medicaid HMOs, and other third-party payors. • Evaluate reimbursement models and recommend improvements to optimize revenue. Payor Relations • Serve as the primary liaison with insurance companies and managed care organizations. • Foster collaborative relationships to support favorable contract terms and issue resolutions. • Develop and deliver compelling presentations on Performance Health’s chronic disease clinical programs. Financial & Operational Oversight • Analyze contract performance, utilization trends, and financial impact. • Collaborate with finance and billing teams to ensure accurate reimbursement and claims processing. Compliance & Risk Management • Ensure all contracts comply with federal, state, and industry regulations. • Monitor changes in healthcare policy and payor requirements, adjusting strategies accordingly. Leadership & Collaboration • Partner with clinical, sales, and operations teams to align payor strategies with service delivery. Qualifications QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Essential Skills: To perform the job successfully, an individual should demonstrate the following: • Adaptability - Accepts and applies feedback. Adapts to changes in the work environment. (Different clinical settings, client changes, supervisor changes, etc.). Changes approach or method to best fit the situation within guidelines and direction from supervisor. Manages competing demands. (Prioritizing responsibilities) • Professionalism - Arrives and begins work prepared and on time. Keeps absences within guidelines. Schedules time off in advance. Keeps commitments. Completes tasks within required guidelines. Displays positive outlook, pleasant manner, and professional appearance. Establishes and maintains effective relations. Works actively to resolve conflicts. • Commitment to Quality– Competent in required job skills and knowledge. Displays understanding of how their actions and job affects others. Exhibits ability to learn and apply new skills. Keeps abreast of current developments. Uses resources effectively. Looks for and takes advantage of opportunities. Pursues training and development opportunities. Seeks feedback to improve performance, asks for help when needed. Strives to continuously build knowledge and skills. Seeks increased responsibilities. • Teamwork – Balances team and individual responsibilities. Contributes to building a positive team spirit. Puts success of team above own interests. Works cooperatively in group situations in commitment to changing the world for children with autism. • Communication - Exhibits good listening and comprehension. Expresses ideas and thoughts respectfully in verbal and written form. Keeps others adequately informed. Selects and uses appropriate communication methods. Edits work for spelling and grammar. Presents numerical data effectively. Varies writing style to meet needs. Writes clearly and informatively. • Organizational Development - Achieves Key Performance Indicator goals. Builds rapport and establishes trust. Initiates new contacts. Benefits organization through outside activities. Maintains client and stakeholder satisfaction. Maintains records and promptly submits information. Presents solutions that meet client and stakeholder objectives and overcomes objections with persuasion and persistence. • Leadership Management - Delegates work assignments. Gives authority to work independently. Matches the responsibility to the person. Provides recognition for results. Sets expectations and monitors delegated activities. Builds commitment and overcomes resistance. Communications change effectively. Prepares and supports those affected by change. EDUCATION AND/OR EXPERIENCE: • Education/Experience: Bachelor’s degree in healthcare or business administration preferred, or related experience. Proven experience of 7+ years of managed care contracting and relationship management experience, preferably in respiratory or home medical equipment (HME) sectors. Strong negotiation, analytical, and communication skills. Deep understanding of payor reimbursement methodologies and regulatory frameworks. • Language Ability: Read, analyze, and interpret complex documents. Respond effectively to sensitive inquiries. Create presentations and articles using innovative techniques. Make persuasive presentations on complex topics to management and public groups. • Mathematical Ability: Comprehend and utilize data analysis. • Reasoning Ability: Solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Interpret a variety of instructions furnished in written, oral, diagram or schedule form. • Computer Skills: Expert in Microsoft Office (Word, PowerPoint, Outlook, Chrome, Internet Explorer, SharePoint). CERTIFICATES, LICENSES, REGISTRATIONS: • Certificates and Licenses: N/A • Valid State Driver’s license in residing state. TRAVEL REQUIREMENTS: • Traveling up to 50% as needed within region/territory. Have reliable means of transportation. Meet the requirements of our Motor Vehicle policy. OTHER SKILLS AND ABILITIES: • Language Ability: Read, analyze, and interpret complex documents. Respond effectively to sensitive inquiries. Create presentations and articles using innovative techniques. Make persuasive presentations on complex topics to management and public groups. • Mathematical Ability: Comprehend and utilize data analysis. • Reasoning Ability: Solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Interpret a variety of instructions furnished in written, oral, diagram or schedule form. • Computer Skills: Expert in Microsoft Office (Word, PowerPoint, Outlook, Chrome, Internet Explorer, SharePoint). All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship. Apply tot his job Apply To this Job