Overview

Chief Managed Care OfficerSouthwest Michigan Behavioral Health • Executive Leadership • Hybrid Reports To Chief Executive Officer FLSA Status Exempt Compensation Commensurate with experience THE CHIEF MANAGED CARE OFFICER OPPORTUNITYAs Chief Managed Care Officer, you'll lead SWMBH's managed care operations as a key member of the executive leadership team - overseeing program integrity, compliance, customer services, and provider network management across the region.WHAT THE CHIEF MANAGED CARE OFFICER WILL OWNExecutive strategy for program integrity, compliance, customer services & provider network managementRegulatory and contractual compliance across Medicaid managed care requirementsDirect oversight of Program Integrity, SIU, and Customer Services leadershipProvider network contracting, negotiation, and performanceAdvising the CEO on managed care risk and organizational strategyWHAT THE CHIEF MANAGED CARE OFFICER NEEDS TO BRINGBachelor's required (JD/Master's preferred) in a related field8+ years progressive leadership in managed care, Medicaid, or healthcare complianceDeep knowledge of PIHP operations and complex contract termsProven track record leading cross-functional teams through change Keep scrolling for the full position details, or jump straight to applying below. CHIEF MANAGED CARE OFFICER - FULL POSITION DETAILSThe Chief Managed Care Officer reports to the CEO and serves as a key member of the senior leadership team, providing executive oversight of program integrity and compliance, customer services, and provider network management. As Chief Managed Care Officer, this role ensures the organization meets federal and state regulations, managed care rules, and contractual requirements - driving access, accountability, quality, and transparency across the region's PIHP managed care responsibilities.CHIEF MANAGED CARE OFFICER DUTIES & RESPONSIBILITIESExecutive Leadership & Regional AlignmentSets strategic direction for managed care functions in alignment with agency mission and federal/contractual obligationsAdvises the CEO and executive leadership on managed care operations, risk, and improvement opportunitiesCollaborates with regional CMHSP partners to ensure delegated managed care functions run effectivelyInterprets contract language, Managed Care Regulations, and the Administrative Code for agency-wide applicationLeads cross-functional planning and implementation for regulatory changes, audits, and corrective actionsEnsures required MDHHS and EQRO reporting/audit standards are metProgram Integrity & ComplianceProvides executive oversight of program integrity and compliance functionsOversees the Director of Program Integrity & SIU and the Compliance OfficerOversees monitoring, reporting, corrective action follow-up, and audit readinessPartners with legal counsel, regulators, and delegated entities to resolve compliance issuesMaintains policies, workflows, and records that support regulatory complianceCustomer ServicesProvides executive oversight ensuring timely, accurate, and culturally responsive customer serviceEnsures effective access for inquiries, complaints, grievances, and appealsSupports the Fair Hearing Process and escalation of complex fair hearing casesMonitors customer service data and trends to inform quality improvementPromotes a customer-focused, transparent, and continuously improving cultureProvider Network ManagementProvides executive oversight ensuring an accessible, qualified, and compliant provider networkOversees provider contracting, credentialing interfaces, and contract complianceNegotiates and operationalizes complex provider agreementsMonitors provider performance, access standards, and network capacityLeads strategies to strengthen provider relationships and resolve network issuesCHIEF MANAGED CARE OFFICER ESSENTIAL FUNCTIONSProvides strategic vision and executive oversight of program integrity, customer services, and provider network managementEnsures managed care operations comply