Director, Managed Care

About the Role:

VMG Health is seeking an experienced and highly motivated Director, Managed Care to lead complex payer contracting and reimbursement engagements for hospitals, health systems, physician groups, ambulatory providers, and other healthcare organizations nationwide.

The Director will serve as a trusted advisor to executive healthcare leaders while developing and executing sophisticated payer contracting strategies designed to optimize reimbursement, improve market positioning, and drive sustainable financial performance. This role requires deep expertise in managed care negotiations, healthcare reimbursement methodologies, payer operations, and provider network strategy.

In addition to consulting and negotiation responsibilities, this individual will play an active role in business development, client relationship management, and identifying opportunities to expand VMG Health's managed care advisory services.

Key Responsibilities:

Client Advisory & Consulting

• Serve as the lead consultant on managed care and payer strategy engagements for hospitals, health systems, physician organizations, ambulatory surgery centers, infusion providers, and other healthcare organizations.
• Conduct comprehensive assessments of payer agreements, reimbursement performance, and market positioning; develop strategic recommendations to improve contract performance and financial outcomes.
• Present findings and recommendations to executive leadership, including CEOs, CFOs, COOs, CMOs, and Boards of Directors.

Payer Contract Negotiations

• Lead negotiations with national and regional commercial health plans, developing strategies supported by financial modeling, market intelligence, and competitive analyses.
• Negotiate reimbursement methodologies, fee schedules, value-based arrangements, policy language, and contract terms; manage renewals, renegotiations, terminations, and network participation strategies.
• Prepare executive-level negotiation summaries and recommendations.

Financial & Market Analysis

• Evaluate reimbursement methodologies including percent of charge, case rates, DRGs, APCs, fee schedules, ASP-based reimbursement, and value-based payment models.
• Collaborate with VMG Health analytics teams to develop financial models supporting negotiation objectives; interpret complex reimbursement data and translate findings into actionable client recommendations.

Business Development & Client Management

• Develop and maintain strong relationships with healthcare executives and key client stakeholders; identify opportunities to expand existing engagements and introduce additional VMG Health service offerings.
• Participate in sales presentations, proposal development, and prospective client meetings; represent VMG Health at industry conferences and professional associations.
• Contribute to thought leadership initiatives, white papers, webinars, and market analyses.

Leadership & Mentorship

• Mentor consultants, analysts, and junior team members; provide oversight and quality assurance for engagement deliverables.
• Support the continued growth and development of VMG Health's Managed Care practice, including developing best practices, methodologies, and negotiation frameworks.

Requirements

Minimum Qualifications:

• Bachelor's degree in Healthcare Administration, Business, Finance, Economics, Public Health, or related field.
• MBA, MHA, MPH, or other advanced degree preferred.
• 10-12+ years of progressive experience in managed care, payer contracting, healthcare reimbursement, or healthcare consulting.
• Significant experience negotiating payer contracts for hospitals, health systems, large physician groups, or other complex provider organizations.
• Demonstrated success leading negotiations with national and regional commercial health plans.
• Experience presenting to executive leadership and boards.
• Preferred: Experience working for a national commercial health plan (UnitedHealthcare, Aetna, Cigna, Elevance, Humana, Molina, Centene, etc.) or large national provider organization (Optum, Envision Healthcare, Team Health, DaVita, Fresenius, etc.).
• Preferred: Knowledge of value-based care, risk-based contracting, and alternative payment models.
• Preferred: Experience supporting mergers, acquisitions, market expansions, and strategic growth initiatives.

Licenses and Certifications:

• No specific licensure required. Active memberships in relevant professional associations (HFMA, AMGA, MGMA) are a plus.

Knowledge & Skills:

• Deep expertise in managed care contracting, payer operations, and healthcare reimbursement methodologies.
• Exceptional negotiation, communication, and relationship management skills with strong executive presence.
• Advanced analytical and financial modeling capabilities; ability to interpret complex healthcare data and translate into strategic recommendations.
• Strong business development and client-facing skills; ability to manage multiple engagements in a fast-paced consulting environment.
• Proficiency in Microsoft Office Suite, including advanced Excel and PowerPoint.