Buscar empleo: 98 ofertas de trabajo de lifetime en St Louis, Missouri (abril 2026)

Regional Director, Managed Care Contracting

hace 16 días

Saint Louis

Job Description EyeCare Partners is the nation's leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision, advance eye care and improve lives. Based in St. Louis, Missouri, over 650 ECP-affiliated practice locations provide care in 18 states and 80 markets, providing services that span the eye care continuum. For more information, visit . SUMMARY Under the strategic direction of the VP, Managed Care, the Regional Director, Managed Care Contracting is responsible for all duties related to managing payer relationships, negotiations, financial modeling, and performance tracking for new and existing payer contracts within a defined geographic region. The primary objectives of this role are to: (a) maximize commercial contract net revenue; (b) proactively identify opportunities to increase revenue, reduce administrative burden, or recover missed reimbursement; and (c) develop long-term strategic payer relationships in support of organizational growth. This position operates in a specialty-specific environment (ophthalmology, retina, and ambulatory surgery centers) and requires fluency in the distinct contracting and reimbursement mechanics of that space — including ASC facility fee structures, J-code drug reimbursement, and multi-TIN contract management across multiple states. The Regional Director works in a matrixed manner with Revenue Cycle Management, Business Operations, Implementation, Financial Modeling, and Provider Enrollment, and serves as the primary escalation contact for payer issues within the assigned region. ESSENTIAL DUTIES AND RESPONSIBILITIES Contract Strategy and Negotiation. Lead strategic development, coordination, and analysis of managed care agreements across all lines of business (Commercial, Medicare, Medicaid, Exchange, and Value-Based). Manage rate development and contract negotiations end to end, with a clear understanding of key decision points and the ability to present options and recommendations to leadership concisely. ASC and Facility Fee Contracting. Negotiate and manage ambulatory surgery center contracts as a distinct discipline from professional fee agreements, including implant and device carve-out provisions, facility cost-of-care arguments, and HOPD parity considerations. Drug Reimbursement and J-Code Management. Maintain working knowledge of J-code drug reimbursement (anti-VEGF agents and other retinal therapeutics), buy-and-bill economics, and pharma contract structures. Identify and act on underpayment patterns in drug reimbursement. Multi-TIN / Multi-State Operations. Manage contract portfolios spanning multiple TINs and states, ensuring consistency of contract terms, rate hierarchies, and payer obligations across a complex organizational structure. Regional Work Plan and Budget. Develop and manage the region's Managed Care Work Plan, annual contracting budget, and payer strategy. Ensure alignment with enterprise-level managed care strategy. Financial Modeling and Analysis. Build and maintain contract models to evaluate rate proposals, forecast revenue impact, and support negotiations. Proficiency in Excel-based fee schedule modeling required; experience with contract management systems preferred. Reporting and Performance Monitoring. Generate and monitor reports, data, and analyses related to managed care contracting for the assigned region. Assess and communicate progress against budget, strategic objectives, and the regional work plan. Escalate issues proactively and keep leadership informed in real time. Payer Relationship Management. Develop and maintain strategic relationships with payer contacts at the regional and national level, including VP-level engagement where appropriate. Navigate situations involving competing commitments, delayed negotiations, or escalation to senior payer leadership. Cross-Functional Collaboration. Partner with RCM, Business Operations, Provider Enrollment, and Finance to coordinate contracting activity, resolve underpayment issues, and support new market development. Represent the Managed Care Department constructively with Regional Operations and clinic leadership. Mentorship and Team Development. Mentor and develop Senior Managed Care Analysts and other team members in all aspects of payer contracting, financial modeling, and strategic analysis. Value-Based Care. Demonstrate familiarity with value-based contract structures, quality metric frameworks, and shared savings or risk-bearing arrangements relevant to the ophthalmology space. Additional Duties. Perform other related duties and special projects as assigned. Be visible and present across the region's clinic locations as needed. QUALIFICATIONS • Sound judgment and effective decision-making skills; ability to gather and apply data to resolve a range of managed care strategy, contracting, and escalation issues., • Extensive knowledge of managed care reimbursement, payer policy, and contracting strategy across Commercial, Medicare, Medicaid, and Exchange lines of business., • Demonstrated experience in ophthalmology, retina, or specialty group practice contracting strongly preferred; candidates with ASC contracting experience given priority consideration., • Strong financial modeling skills; advanced Excel proficiency required. Experience with contract management platforms preferred., • Familiarity with J-code drug reimbursement, anti-VEGF buy-and-bill economics, and pharma contract structures., • Proven track record of successful contract negotiations across multiple markets and states, including experience managing multi-TIN contract portfolios., • Experience identifying and recovering underpayments through RCM coordination and payer escalation., • Ability to identify opportunities and threats and develop action plans involving multiple internal and external stakeholders., • Ability to navigate senior payer relationships, including VP-level escalation when necessary., • Experience with value-based care contracting structures is a plus., • Additional experience in RCM and/or finance is a plus., • Strong written and verbal communication skills; ability to present complex contracting issues clearly to executive leadership., • Positive change leadership orientation; ability to mentor junior team members and serve as a model for the department., • Ability to work in a fast-paced environment, manage competing priorities, and meet deadlines., • EDUCATION AND/OR EXPERIENCE, • 8 + years of experience in a position that is directly responsible for contract negotiations for a payor, provider, or both., • Bachelor's Degree focused on health care administration, business, or finance. Will accept 10 years of progressive direct contracting experience in addition to 2 years of experience working in RCM in leu of a degree., • Master's degree: MSPH, MHA or MBA preferred., • Proven track record of managing contract negotiations in multiple markets and states. SYSTEMS AND TECHNOLOGY • Advanced proficiency in Microsoft Excel (including fee schedule modeling and financial analysis), Word, PowerPoint, and Outlook required., • Experience with contract management systems preferred., • Familiarity with payer portals, remittance analysis tools, and RCM data reporting systems preferred., • Experience with data visualization tools (e.g., Power BI, Tableau) a plus.

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