Corporate Director of Insurance Contracts & Case Management

Job Description

Job Description

Corporate Director of Insurance Contracts & Case Management  

Position Summary  

ALIYA Healthcare is seeking an experienced and strategic Corporate Director of Insurance Contracts & Case Management to lead the organization’s insurance contracting strategy and oversee the corporate Case Management team across our skilled nursing facilities. 

This position will be responsible for managing the development, negotiation, implementation, and renewal of insurance contracts, while ensuring contracted rates, terms, and reimbursement structures align with the organization’s financial and operational objectives. The Director will serve as a key corporate liaison with insurance companies, managed care organizations, Medicare Advantage plans, and other payers. 

In addition, this position will provide leadership and oversight to the organization’s Case Management team, ensuring effective management of resident cases, payer requirements, authorizations, clinical documentation, length of stay, and communication with insurance providers. 

The ideal candidate will have strong knowledge of managed care, insurance contracting, skilled nursing reimbursement, case management, payer negotiations, and healthcare operations, with the ability to work collaboratively with facility and corporate leadership. 

Key Responsibilities  

• Lead the negotiation, implementation, and renewal of insurance and managed care contracts across the organization.  

• Serve as the primary corporate contact for insurance companies, managed care organizations, and other payer partners.  

• Review and analyze contract terms, reimbursement rates, and payer requirements to identify financial opportunities and risks.  

• Maintain oversight of all insurance contracts, renewal timelines, amendments, and payer agreements.  

• Develop and maintain strong relationships with payer representatives and address contract and reimbursement issues.  

• Oversee the Corporate Case Management team, including performance, workflows, and accountability.  

• Ensure effective management of authorizations, continued stay reviews, payer communications, and utilization management.  

• Monitor denials, non-covered days, length of stay, and other case management metrics to identify opportunities for improvement.  

• Partner with facility leadership, Reimbursement, Clinical, Admissions, and Finance teams to resolve payer and case management issues.  

• Develop and implement standardized processes and best practices for insurance contracting and case management.  

• Provide regular reporting to executive leadership on contract performance, payer trends, case management outcomes, and reimbursement opportunities.  

• Identify opportunities to improve payer terms, increase reimbursement, reduce denials, and strengthen overall payer performance. 

• Establish measurable KPIs for the Case Management team and monitor performance regularly. 

Qualifications  

• Bachelor's degree in Healthcare Administration, Business Administration, Nursing, Finance, or a related field preferred. 

• 5+ years of healthcare experience, with significant experience in insurance contracting, managed care, case management, reimbursement, or payer relations. 

• Experience working with skilled nursing facilities, long-term care, post-acute care, or healthcare organizations strongly preferred. 

• Strong understanding of Medicare, Medicare Advantage, Medicaid, managed care, and commercial insurance. 

• Demonstrated experience negotiating and managing healthcare insurance contracts. 

• Strong understanding of skilled nursing reimbursement and payer authorization processes. 

• Previous leadership or management experience required. 

• Strong analytical and financial skills with the ability to evaluate contracts and reimbursement structures. 

• Excellent negotiation, communication, and relationship-building skills. 

• Strong knowledge of healthcare regulations, payer requirements, and contractual compliance. 

• Ability to analyze data, identify trends, and make strategic recommendations. 

• Strong organizational skills with the ability to manage multiple contracts, payer relationships, and priorities simultaneously. 

• Proficiency in Microsoft Office, particularly Excel. 

• Ability to travel to facilities and payer meetings as needed. 

Benefits  

• Medical Insurance 

• Dental Insurance 

• Vision Insurance 

• Flexible Spending Account (FSA) 

• Life Insurance 

• Critical Illness Insurance 

• Short-Term Disability Insurance 

• Accident Insurance 

• Hospital Indemnity Insurance 

• 401(k) Retirement Savings Plan 

• On-Demand Pay Option 

• Paid Time Off (PTO) 

• Tuition Reimbursement Program 

Join Our Team  

This is an opportunity to play a critical role in the growth and financial performance of ALIYA Healthcare. The Corporate Director of Insurance Contracts & Case Management will have a direct impact on payer relationships, reimbursement, case management performance, and the organization’s overall operational and financial success. 

If you are an experienced healthcare leader with a strong background in insurance contracting, managed care, reimbursement, and case management, we encourage you to apply.