Responsible for negotiating and securing all Payor contracts, private and public, for Pentec Health in the assigned geography. This position is accountable for establishing and maintaining positive long-term relationships with key personnel in targeted payors in order to secure and maintain in-network status for Pentec Health.

**Travel required, about once per month.**

Essential Job Duties:

• Under minimal supervision, the Director of Managed Care leads all Pentec Health initiatives with targeted regional managed markets accounts, which include Regional Independents, Blue Plans, Medicare Part D and Managed Medicaid.
• Conceiving, creating and managing the negotiation, analyzing profitability, positioning the agreement internally, coordinating the selling effort, creating the marketing plan, insuring effective and efficient pull-through, forecasting and measuring its results, and conducting ongoing business reviews.
• Work with Executive Leadership to develop account targets for securing participating provider contracts in each new market.
• Meet directly with key payor personnel to establish a relationship between them and Pentec Health and to differentiate us versus competition.
• Work closely with Field Sales Team to secure participating provider contracts for key plans affecting targeted referral sources in new and existing geographies.
• Thoroughly understand the clinical services and specific market segment messages as it relates to Targeted Drug Delivery, Renal Nutrition, and Medical Foods, and other Pentec Products and Services.
• Assist Reimbursement team with outstanding claims issues.
• Monitor internal reports as they relate to managed care performance, identify and develop strategies for measurable improvement for payors in assigned geographic markets.
• Responsible for communicating and ensuring implementation of applicable updates to payors’ policies/procedures and administrative processes.

*Other job duties and special projects as assigned.

Ideal Candidate Will Have:

• Bachelor’s Degree (BA, BSN) or equivalent work experience. (MBA, R.D, is preferred but not required)
• At least 5 years of Managed Care experience or related healthcare experience and of documented success with large account management. Prefer Specialty Pharmacy, DME, Enteral Nutrition, or Home Infusion background.
• Strong self-starter initiative, ability to negotiate contracts, and expand on solid business relationships with influential customers, both internal and external.
• The account management aspect will demand a high level of performance, strategic/financial analysis and interaction with multiple decision-makers. A high level of communication and leadership is necessary to provide strategic direction to numerous personnel.
• Proven ability to develop, plan, implement and follow through with action plans that positively influence opportunities. Positive communication and teamwork skills and a documented ability to work with all levels of personnel.
• Strong analytical skills, highly organized, and detail and process oriented. Ability to problem solve involving several concrete variables in standardized situations.
• Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form. Experience preparing and presenting quarterly Business Review presentations to health plans.
• Understands how to work the health plan matrix by calling on many different clients within the account, track record of account management and upsell success.

Physical Requirements:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to travel via car, stand, sit, walk, see, hear, use hands and fingers regularly, handle, or feel objects, tools, or controls, and reach with hands and arms.

The employee must frequently lift and/or move up to 5 pounds and occasionally lift and/or move up to 40 pounds.

Salary Range: $135,000- $145,000 annual

Pentec Health offers a comprehensive compensation and full benefits package. Actual pay will be based on several factors such as qualifications and skills for the role plus geographic location.

Benefits may include but are not limited to medical, dental, vision, 401k match, PTO, paid holidays, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits