Director of Managed Care and Contracting

Job Details: Job Location: Houston Head Office - Houston, TX, Position Type: Full Time, Salary Range: Undisclosed, Job Category: Health Care,  

 Performance Home Medical has been a leader in providing quality products and services since 1995.

At Performance Home Medical (PHM), our patients come first. We use the latest technology with compassionate clinical support to empower individuals in managing their conditions, helping them live longer, healthier, and more independent lives.

We are seeking a dynamic, strategic, and results-driven Director or Vice President of Managed Care and Contracting, depending on experience, to lead and optimize our payer strategy and provider agreements. This key leadership role is responsible for developing, negotiating, and managing managed care contracts that align with our organization's financial goals and patient care priorities. The ideal candidate will bring strong executive leadership capabilities, deep industry expertise, and qualities that resonate with the collaborative and mission-driven culture at Performance Home Medical, a leading provider of medical supplies. For exceptionally qualified candidates with a proven track record of strategic leadership and organizational impact, this role may be filled at the Vice President level.

This remote position provides support across our markets in Washington, Oregon, Idaho, and Texas.

POSITION SUMMARY: 

The Director of Managed Care and Contracting is a senior leadership role responsible for developing, negotiating, and managing payor relationships and contracts across the organization’s service markets. This individual plays a pivotal role in ensuring patients receive uninterrupted access to high-quality care during periods of organizational change and growth, serving as a trusted liaison between the company and its managed care partners.

The ideal candidate is a seasoned managed care professional who brings deep knowledge of payor reimbursement structures, a collaborative spirit, and the drive to build lasting relationships with payers, patients, and internal stakeholders alike.

KEY RESPONSABILITIES: 

Contracting & Payor Relations

Lead the negotiation, execution, and management of managed care contracts with commercial, Medicare Advantage, Medicaid, and other third-party payors.
Develop and maintain strong, trust-based relationships with payor representatives to ensure favorable contract terms and continuity of care.
Serve as the primary point of contact for payor escalations, audits, and contract renewals.
Monitor contract performance, reimbursement trends, and payor policy changes to proactively address risks and opportunities.

Market Continuity & Patient Access

Champion patient continuity of care initiatives during transitions, acquisitions, or market changes, ensuring minimal disruption to patients and referring providers.
Collaborate cross-functionally with clinical, operations, and finance teams to align contracting strategies with patient care goals.
Identify and develop new payor relationships to expand network participation and market access.

Analytics & Strategy

Analyze reimbursement data, utilization trends, and payor performance metrics to inform negotiation strategies and organizational decision-making.
Prepare and present contract proposals, financial models, and managed care reports to senior leadership.
Stay current on regulatory changes, payor reimbursement methodologies, and industry best practices in managed care.

Leadership & Team Development

Provide guidance and oversight to managed care staff, delegating responsibilities appropriately and fostering a culture of accountability and continuous improvement.
Mentor team members and support their professional development and growth.
Build and maintain cross-departmental relationships to ensure organizational alignment on managed care objectives.

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Essential Skills: To perform the job successfully, an individual should demonstrate the following:

Adaptability - Accepts and applies feedback. Adapts to changes in the work environment. (Different clinical settings, client changes, supervisor changes, etc.). Changes approach or method to best fit the situation within guidelines and direction from supervisor. Manages competing demands. (Prioritizing responsibilities)
Professionalism - Arrives and begins work prepared and on time.  Keeps absences within guidelines. Schedules time off in advance. Keeps commitments.  Completes tasks within required guidelines. Displays positive outlook, pleasant manner, and professional appearance. Establishes and maintains effective relations.  Works actively to resolve conflicts.
Commitment to Quality– Competent in required job skills and knowledge. Displays understanding of how their actions and job affects others. Exhibits ability to learn and apply new skills. Keeps abreast of current developments. Uses resources effectively. Looks for and takes advantage of opportunities. Pursues training and development opportunities. Seeks feedback to improve performance, asks for help when needed. Strives to continuously build knowledge and skills. Seeks increased responsibilities.
Teamwork – Balances team and individual responsibilities. Contributes to building a positive team spirit.   Puts success of team above own interests. Works cooperatively in group situations in commitment to changing the world for children with autism.
Communication - Exhibits good listening and comprehension. Expresses ideas and thoughts respectfully in verbal and written form. Keeps others adequately informed. Selects and uses appropriate communication methods. Edits work for spelling and grammar. Presents numerical data effectively. Varies writing style to meet needs. Writes clearly and informatively.
Organizational Development - Achieves Key Performance Indicator goals. Builds rapport and establishes trust. Initiates new contacts. Benefits organization through outside activities. Maintains client and stakeholder satisfaction. Maintains records and promptly submits information.  Presents solutions that meet client and stakeholder objectives and overcomes objections with persuasion and persistence.   
Leadership Management - Delegates work assignments. Gives authority to work independently.  Matches the responsibility to the person. Provides recognition for results. Sets expectations and monitors delegated activities. Builds commitment and overcomes resistance. Communications change effectively. Prepares and supports those affected by change. 

Education & Experience

Bachelor’s degree in healthcare administration, business, or a related field required; advanced degree preferred.
7+ years of progressive experience in managed care contracting and payor relationship management.
Prior experience in respiratory therapy, home medical equipment (HME), or related healthcare services strongly preferred.
Demonstrated success negotiating complex managed care agreements with commercial and government payors.

Knowledge, Skills & Abilities

Deep understanding of payor reimbursement methodologies, fee schedule structures, and managed care regulatory frameworks.
Exceptional negotiation skills with the ability to achieve favorable outcomes while preserving strong payor relationships.
Strong analytical abilities; proficient in interpreting data and translating insights into actionable strategy.
Excellent written and verbal communication skills; able to present complex information clearly to diverse audiences.
Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, SharePoint).
Highly organized with the ability to manage multiple priorities and competing deadlines.

Core Competencies: 

Adaptability – Navigates change with professionalism; adjusts approach to fit evolving clinical, operational, and payor environments.
Professionalism – Consistently demonstrates reliability, punctuality, and a positive, solution-oriented attitude.
Commitment to Quality – Continuously pursues skill development and operational excellence; seeks feedback and improvement.
Teamwork – Builds team cohesion and places collective success above individual recognition.
Communication – Communicates clearly and persuasively in both written and oral formats; adapts messaging to the audience.
Organizational Development – Achieves KPI goals; builds stakeholder trust and maintains high levels of satisfaction.
Leadership – Delegates effectively, sets clear expectations, supports team through change, and provides meaningful recognition.

Additional Requirements: 

Travel up to 50% within assigned region/territory as needed.
Valid state driver’s license in state of residence; must meet Motor Vehicle policy requirements.
Reliable transportation required.

All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.