MANAGED CARE DIRECTOR SKILLS, EXPERIENCE, AND JOB REQUIREMENTS

Published: Apr 03, 2025 – The Managed Care Director has extensive experience managing healthcare programs across medical groups and hospitals, with strengths in staff development, strategic planning, and operational leadership. This role requires skills in contract negotiation, financial analysis, and navigating the complexities of managed care and medical reimbursement. The director also has strong communication and relationship-building abilities with proven success engaging executive leadership, physician partners, and healthcare stakeholders.

Essential Hard and Soft Skills for a Standout Managed Care Director Resume
  • Contract Negotiation
  • Strategic Planning
  • Financial Analysis
  • Value Contracting
  • Rate Negotiation
  • Data Analysis
  • Credentialing Oversight
  • Budget Management
  • Business Development
  • Market Analysis
  • Problem Solving
  • Team Leadership
  • Stakeholder Communication
  • Cross-functional Collaboration
  • Relationship Management
  • Issue Resolution
  • Interpersonal Communication
  • Performance Coaching
  • Client Engagement
  • Process Improvement

Summary of Managed Care Director Knowledge and Qualifications on Resume

1. BA in Business Administration with 8 years of Experience

  • Experience in the pharmaceutical/biotechnology industry, with experience in a managed care/market access analytical, operations, or pricing function
  • Familiarity with secondary data as well as data from Specialty Distributors/Wholesalers, Group Purchasing Organizations, and pricing and discount programs
  • Strong expertise in analyzing data to qualify and quantify business opportunities in a broad range of managed care/access channels
  • Ability to lead the introduction and implementation of advanced analytical tools and processes
  • Ability to perform analysis to inform new product pricing and contracting strategy, and decision-making
  • Demonstrated experience analyzing complex situations and processes, and effectively integrating and synthesizing the data to form a complete, cohesive picture
  • Proven self-starter with high standards of excellence and an innovative mind
  • Strong interpersonal, communication, influencing, and analytical skills
  • Ability to analyze and synthesize complex data and provide summarized recommendations and clear guidance to leadership
  • Ability to manage multiple projects and consistently meet deadlines
  • Excels at interacting with a diverse group of people at all levels of management, including senior leadership
  • Strong written and verbal communication skills
  • Excellent PowerPoint and Excel skills

2. BA in Healthcare Administration with 9 years of Experience

  • 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 the 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.
  • Ability to travel to the corporate office and within assigned regions.
  • Strong negotiation and interpersonal skills, strong written, verbal, and analytical skills
  • Motivated and a proactive strategist with the ability to adhere to deadlines, work to “get the job done”
  • Must be a “self-starter” with the ability to multitask.
  • 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 (i.e., case rates, unit rates, fee for service, etc.).
  • Proficient in creating and utilizing MS Excel spreadsheets and all other MS Office programs.
  • Active and unrestricted NYS RN license
  • Knowledge of the UAS-NY assessment
  • Proficient in the use of Microsoft Office Suite tools, including Word, PowerPoint, and Excel

3. BA in Business Administration with 10 years of Experience

  • Managed care working experience
  • A significant background in negotiations, contracting, and hospital/physician clinical operations.
  • Proven track record of managing and closing negotiations (language and rate) on time and at or exceeding budget expectations.
  • Working knowledge of value-based arrangements, including risk/capitation, bundling, or shared savings arrangements.
  • Familiarity with integrated care and payment models that align financial incentives to support quality outcomes, patient/member satisfaction, and cost-effective care delivery.
  • Demonstrated success/knowledge of Value-Based Contracting, Risk, Capitation, Clinically Integrated Networks, Revenue Sharing, and Rate Setting.
  • Strong written and verbal executive-level communication skills.
  • Excellent project management skills.
  • Ability to exercise good time management and priority setting
  • The ability to keep multiple projects on track simultaneously and excellent organizational skills.
  • Strong negotiating experience with hospitals, integrated health systems, or health plans
  • Must be abreast of industry trends, including those related to PPACA, Medicaid Reform, MACRA, Pricing Transparency, Medicare Advantage risk models, and CMS/Commercial Payer Alternative Payment Models.
  • Familiarity with Microsoft Windows, Microsoft Office, and e-mail (Microsoft Outlook or Exchange).

4. BA in Health Services Administration with 11 years of Experience

  • Broad experience managing and leading programs in a healthcare setting, including both medical group and hospital experience, and work units or departments of comparable size, scope, and complexity
  • Ability to manage, coach, and develop employees as well as provide leadership and influence others
  • Ability to communicate effectively at all organizational levels and in situations requiring instructing, persuading, negotiating, conflict resolution, consulting, and advising, as well as preparing clear, comprehensive written and oral reports and materials
  • Ability to establish the strategic direction and business plans for a functional group
  • Ability to administer and negotiate contractual agreements
  • Knowledge of health care, marketing, managed care strategy, financial/contract analysis, and the medical reimbursement environment
  • Must have proven management experience and the ability to manage staff.
  • Experience with medication pass and certification as a Med Aide as required by state law.
  • Healthcare/managed care-related experience, progressive level of responsibility, experience with ASC
  • Must be able to interact with System Partners, Physician partners, executive USPI Leadership, Payor Executive Leadership
  • Full understanding of the current healthcare environment/industry and managed care (payer or provider)
  • Strong skills in oral and written communication, at both executive level and front-line level, relationship building and maintenance, and contract negotiation
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