Overview

Position: Director, Managed Care Contracting Location: Greater Los Angeles, CA Worksite: In office Employment Type: Full Time Compensation: $130k to $220k plus bonus FocusPoint Confidential Healthcare Client Compensation: $130k $220k + bonus opportunity + full benefits Location: Greater Los Angeles, California (onsite) Our client, a respected healthcare organization in the Greater Los Angeles region, is seeking an experienced Director of Managed Care Contracting to lead payor strategy, contract performance, and Revenue Integrity functions. This is a high impact leadership role responsible for advancing reimbursement outcomes, strengthening payor relationships, and driving financial sustainability across a complex acute care environment. About the Role The Director of Managed Care Contracting provides strategic leadership for payor contracting, reimbursement performance, and Revenue Integrity operations. This leader oversees contract strategy, negotiations, renewals, implementation, analytics, and performance management across commercial, government, and value based arrangements. The role partners closely with executive leadership to evaluate payor proposals, reimbursement methodologies, operational requirements, and financial impact. Key Responsibilities Managed Care Contracting & Payor Strategy Lead the full lifecycle of managed care contracting, including negotiation, renewal, execution, implementation, and administration of fee for service, capitation, value based, bundled service, and LOA arrangements. Evaluate payor proposals, reimbursement methodologies, contract terms, operational requirements, and financial impact. Direct contract language review and amendment to mitigate reimbursement exposure, authorization delays, policy changes, denial trends, underpayments, and compliance risks. Drive strategic direction for commercial, HMO/PPO, Medicare Advantage, Medi Cal/Medicaid, and other payor arrangements. Revenue Integrity, Reimbursement & Contract Performance Provide strategic leadership for Revenue Integrity functions, ensuring accurate reimbursement, compliance with contract terms, and effective underpayment resolution. Direct financial, operational, payor, and denial analytics to evaluate trends, revenue impact, claims activity, and opportunities for improvement. Lead disciplined contract performance reviews with recommendations for renewal, expansion, modification, termination, or escalation. Oversee executive dashboards that convert claims, denials, reimbursement trends, and payor behavior into actionable insights. Denials Analytics, Escalation & Prevention Lead Denials Analytics across hospital and ambulatory settings, including appeals strategy, payor escalations, and Provider Relations coordination. Serve as senior escalation point for complex payor, contract, reimbursement, authorization, underpayment, and denial matters. Drive cross functional root cause analysis with Patient Access, UM, Case Management, CDI, HIM, ambulatory leadership, physicians, Finance, and Revenue Cycle. Advance organization wide denial prevention strategies aligned with contract terms, payor requirements, documentation standards, and billing workflows. Contract Operationalization & Cross Functional Leadership Oversee operational implementation of managed care contracts, ensuring accurate rate setup, authorization alignment, payor policy communication, workflow readiness, and post implementation monitoring. Lead payor relations and cross functional engagement through governance meetings, joint operating sessions, issue resolution forums, and ongoing communication. Process Improvement, Systems & Operational Excellence Lead workflow modernization, automation, and technology enabled process improvement initiatives. Establish intake, triage, tracking, escalation, and accountability structures for payor issues, reimbursement disputes, authorization barriers, LOA requests, denial trends, and underpayments. Use continuous improvement methods, benc