DIRECTOR OF MANAGED CARE SKILLS, EXPERIENCE, AND JOB REQUIREMENTS
Updated: Mai 27, 2025 - The Director of Managed Care demonstrates expertise in negotiating payer contracts and value-based payment arrangements, driving collaboration and innovation. Excels in relationship building with stakeholders and managing multiple projects effectively. Proficient in patient accounting, reimbursement analysis, and digital tools within the managed care environment.
Essential Hard and Soft Skills for a Standout Director of Managed Care Resume
- Payer Contract Negotiation
- Value-Based Payment Models
- Patient Accounting
- Reimbursement Analysis
- Billing and Collections
- Data Analysis
- Healthcare Regulations Knowledge
- Financial Modeling
- Managed Care Software Proficiency
- Strategic Planning
- Communication
- Negotiation
- Leadership
- Relationship Building
- Collaboration
- Analytical Thinking
- Time Management
- Problem Solving
- Adaptability
- Decision Making
Summary of Director of Managed Care Knowledge and Qualifications on Resume
1. BA in Healthcare Administration with 10 Years of Experience
- Demonstrated experience in leadership negotiating and managing contracts within the healthcare industry working on either the health plan or provider side.
- Previous management experience including responsibilities for hiring, training, assigning work, and managing performance of staff.
- Demonstrated strong knowledge of managed care regulations, state legislation, and laws related to health care and health care operations, as well as value-based and analytical models.
- Strong negotiation and interpersonal skills, strong written, verbal, and analytical skills, motivated and proactive strategist with the ability to adhere to deadlines, and work to “get the job done”.
- Must be a “self-starter” with the ability to multi-task.
- Superior strategic and critical thinking skills with the ability to effectively communicate clear and concise direction to all levels.
- Professional business sense and presentation skills, strong knowledge of reimbursement methodology types
- Proficient in creating and utilizing MS Excel spreadsheets and all other MS Office programs.
2. BA in Business Administration with 5 Years of Experience
- Experience in negotiating payer contracts within a health system or hospital, experience on the payer side
- Exceptional interpersonal skills for communications, collaboration, relationship building with internal and external stakeholders
- Strong negotiation and analytical skills
- Digitally savvy and proficient with computer hardware/software programs in the managed care arena
- Experience and understanding of new and evolving value-based payment arrangements, such as capitation, shared savings, and payment bundles.
- Solid understanding of patient accounting tasks including billing, collections, and reimbursement analysis.
- A track record of success working in an environment of collaboration, transparency, mutual respect, and shared passion for excellence and innovation.
- Ability to plan, organize, prioritize, allocate resources, and manage multiple ongoing, concurrent projects.
- Ability to express oneself clearly and concisely both orally and in writing with staff, physicians, and management personnel both within the organization as well as the payor community.
3. BA in Public Health with 5 Years of Experience
- Managed care experience with a demonstrated history of increasing responsibility
- Experience with managed care, worker compensation and insurance plans in terms of winning business, relationship management and developing the account (revenue growth)
- Work independently and take initiative, anticipating and resolving problems while managing multiple priorities and projects
- Ability to build relationships with external vendors and ability to collaborate outside of the department to enlist the cooperation of other organizational stakeholders
- Strong decision-making skills and a willingness to adapt to changing priorities
- Strong PC skills including Excel, Microsoft Word, PowerPoint and Outlook
- Excellent written, verbal and interpersonal communication skills
- Highly developed negotiation and contract management skills
- Excellent analytical skills
- Knowledge of provider contracting, financial arrangements and fee schedules
- Proven success at managing and motivating a team with the ability to set clear goals and hold teams accountable
4. BA in Economics with 9 Years of Experience
- Deep knowledge and the ability to influence how payers make decisions.
- Strong communication skills including written, verbal and presentation ability.
- In depth knowledge of the DME and Home Healthcare market
- Ability to balance between the strategic and tactical aspects of contracts.
- Self-motivated and self-sufficient with a passion for completion.
- Exceptional project management, organization and attention to detail.
- Critical thinking skills and the ability to research and understand legal and financial implications.
- Ability to sell Byram services utilizing a structured sales process.
- Must be able to effectively sell Byram's value proposition
- Must be able to attend trade shows, conferences, association meetings, and educational seminars
- Develop creative solutions to identified customer issues
- Must be able to respond in a manner that improves the customer relationship.
- Experience with at least selling healthcare services to national or regional managed care organizations.
5. BA in Finance with 6 Years of Experience
- Skilled negotiator with a proven track record and ability to achieve results in challenging environments, including direct experience in contract negotiations
- Possess a strong understanding of the healthcare industry and payor-provider reimbursement methodologies as well as pricing strategies
- Develop and maintain a deep understanding of state and federal legislation related to payment initiatives and policy changes
- Excellent written and oral communication skills, confident and impactful presenter
- Experience including supervision, managed care contracting, financial analysis, payment methodologies, contract language and negotiations
- Equivalent experience considered
- Experience in Managed Care or Contracting in a life sciences, payer setting
- Management experience with a managed care team
- Experienced working with payers at a laboratory that bills molecular tests.
- Experience and knowledge of federal and state legislative environments and regulatory processes to dissect complex scenarios and are able to bring issues to swift resolution.
- Ability to develop relationships with both internal and external stakeholders