Vice President of Managed Care | PAM Health Corporate

Overview

The Vice President (VP) of Managed Care is responsible for the strategic leadership, development, and execution of all managed care and payor engagement initiatives across a multi-state platform of Inpatient Rehabilitation Facilities (IRFs) and Long-Term Acute Care Hospitals (LTACHs). This role leads enterprise-wide contracting strategy, reimbursement optimization, and payor partnerships to drive sustainable growth, operational performance, and financial outcomes across diverse post-acute care markets.The VP establishes a scalable, market-responsive managed care framework that accounts for state-specific regulatory requirements, reimbursement methodologies, and evolving payor dynamics, ensuring alignment with organizational objectives and compliance standards. As a key member of the leadership team, the VP partners closely with Operations, Finance, Clinical Leadership, and Revenue Cycle to integrate managed care strategies that support patient access, appropriate utilization, and margin optimization across all regions. 

Responsibilities

Contracting & Payor Relations 

• Oversee negotiation, execution, and management of all managed care contracts (commercial, Medicare Advantage, Medicaid, and other payors) 

• Establish and maintain strong relationships with national, regional, and local payors 

• Ensure favorable contract terms, reimbursement rates, and performance metrics  

Financial Performance & Optimization 

• Drive reimbursement strategies that improve revenue and margin performance 

• Partner with finance and revenue cycle to monitor contract performance, denials, and payment trends 

• Identify opportunities for rate improvement and contract renegotiation 

Operational Partnership 

• Collaborate with operations and clinical leadership to align managed care initiatives with care delivery models 

• Support admissions and case management teams in navigating payor requirements and authorizations 

• Ensure alignment between payor expectations and operational workflows 

Compliance & Risk Management 

• Ensures compliance with all federal, state, and local regulatory requirements related to managed care contracting, reimbursement, and billing across IRF, LTAC, and other post-acute care settings  

• Monitors and interprets changes in CMS regulations, healthcare laws, and reimbursement policies impacting IRF, LTAC, and post-acute services, ensuring timely organizational alignment  

• Oversees compliance with payor contract terms and regulatory standards across multi-state operations, including varying state-specific licensing, reimbursement, and utilization requirements  

• Partners with Legal, Compliance, and Revenue Cycle leadership to proactively mitigate risk, ensure audit readiness, and address regulatory or payor-related issues 

Leadership & Team Development 

• Lead, mentor, and develop managed care and payor relations teams 

• Foster a collaborative, high-performance culture focused on accountability and results 

• Provide oversight of regional and corporate managed care functions 

 Leadership

• Inclusiveness: Promotes cooperation, fairness and equity; shows respect for people and their differences; works to understand perspectives of others;     demonstrates empathy; brings out the best in others and in his/her team 

• Managing Staff:  Coaches, evaluates, develops, and inspires staff; sets expectations; recognizes achievements 

• Stewardship and Resource Management: Demonstrates accountability and sound judgment in managing company resources; appropriate understanding of confidentiality and company values; adheres to and supports company policies, procedures and safety guidelines 

• Problem-Solving: Identifies problems and involves others in seeking solutions; conducts appropriate analysis and searches for best solutions; effectively and efficiently implements appropriate responses to correct problems; responds promptly and effectively to new challenges 

• Decision-Making:  Makes clear, consistent decisions; acts with integrity in all decisions; distinguishes relevant from irrelevant information; makes timely, appropriate decisions. 

• Strategic Planning and Organizing: Understands company vision and aligns priorities accordingly; measures outcomes; uses feedback to redirect as required; evaluates alternatives; appropriately organizes complex issues to desirable resolution 

• Communication: Connects with peers, subordinate employees and all customers; actively listens; clearly and effectively shares information; demonstrates effective oral and written communication skills; negotiates effectively. 

• Quality Improvement: Strives for efficient, effective, high-quality performance in self and in the department; delivers timely and accurate results; resilient when responding to matters that are challenging; takes initiative to make improvements 

• Leadership: Motivates others; accepts responsibility; maintains high morale in department; develops trust and credibility; expects honest and ethical behavior of self and staff 

• Teamwork: Encourages cooperation and collaboration; builds effective teams; works in partnership with others; is flexible; responsive to the needs of others 

• Development: Maintains up-to-date skills through involvement with professional organizations and/or continuing education 

• Maintains the highest level of customer service via courtesy, compassion and positive communication. 

• Promotes the mission and vision of PAM Health within the work environment and the community. 

• Respects dignity and confidentiality by adherence to all applicable policies and procedures. 

• Works in a manner that promotes safety; wears clothing appropriate to the performance of the job. 

• Participates in OSHA required training. 

• Follows universal precautions as appropriate for position; complies with Employee Health requirements for continued employment. 

• Reports unsafe practices to management. 

• Knows own role in case of an emergency. 

Qualifications

Education and Training:  Bachelor’s degree in Healthcare Administration, Business, Finance, or related field required. Master’s degree (MBA, MHA, or similar) strongly preferred 

Experience:    

• 10+ years of progressive leadership experience in managed care, payor contracting, or healthcare administration  

• Significant experience within post-acute care, hospital systems, or healthcare services  

• Proven success in contract negotiation, payor strategy, and revenue optimization 

Knowledge, Skills, and Abilities: 

• 10+ years of progressive leadership experience in managed care, payor contracting, or healthcare administration  

• Significant experience within post-acute care, including IRF and LTAC settings strongly preferred  

• Experience working within multi-state healthcare organizations with an understanding of varying regulatory and reimbursement environments