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Director, Managed Care - Job Opportunity at Pentec Health

Remote, US
Full-time
Senior
Posted: April 2, 2025
Remote
USD 135,000 - 145,000 per year

Benefits

Competitive 401(k) matching program demonstrating strong retirement focus
Comprehensive medical, dental, and vision coverage indicating investment in employee health
Short and long-term disability protection providing income security
Life insurance coverage for financial protection
Flexible PTO and paid holidays supporting work-life balance
Health savings account option for tax-advantaged healthcare spending
Employee assistance program showing commitment to wellbeing
Flexible spending accounts for additional tax benefits

Key Responsibilities

Lead strategic managed care initiatives for regional markets including Blue Plans, Medicare Part D and Managed Medicaid
Drive contract negotiations and profitability analysis for network participation
Develop and execute market entry strategies for new territories
Build and maintain key payor relationships to secure competitive advantages
Collaborate with sales teams to align provider contracts with business development goals
Oversee clinical services positioning across specialty product lines
Manage claims resolution and payor policy implementation
Direct performance monitoring and improvement strategies for assigned markets

Requirements

Education

Bachelor's Degree (BA, BSN) required, MBA or R.D. preferred

Experience

5+ years of Managed Care or related healthcare experience

Required Skills

Contract negotiation expertise Strategic and financial analysis capabilities Strong leadership and communication abilities Project management skills Healthcare market knowledge Relationship building proficiency Analytical and problem-solving skills Presentation and business review experience
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Sauge AI Market Intelligence

Industry Trends

The managed care sector is experiencing significant transformation due to value-based care initiatives and specialty pharmacy integration Rising specialty drug costs are driving increased focus on pharmacy benefit management and specialized contracting Digital health integration is reshaping payor-provider relationships and creating new opportunities for innovative care delivery models

Salary Evaluation

The offered salary range of $135,000-$145,000 is competitive for a remote Director-level position in managed care, though slightly below market for candidates with specialty pharmacy expertise in major markets where ranges typically extend to $160,000-$175,000

Role Significance

Typically leads a small specialized team of 3-5 professionals while coordinating extensively with cross-functional departments
Director-level position with significant strategic influence on market access and revenue generation

Key Projects

Multi-state payor contract negotiations and implementations Market access strategy development and execution Network optimization and expansion initiatives Value-based care program development

Success Factors

Deep understanding of specialty pharmacy reimbursement landscape Strong negotiation skills combined with strategic thinking Ability to build and maintain relationships across multiple stakeholder groups Experience in value-based contracting and alternative payment models

Market Demand

High demand position due to growing complexity of managed care contracting and increasing focus on specialty pharmacy services integration

Important Skills

Critical Skills

Managed care contract negotiation expertise is essential for driving market access and revenue growth Strategic analysis capabilities necessary for evaluating market opportunities and contract profitability Relationship management skills crucial for maintaining payor partnerships

Beneficial Skills

Experience with value-based care models increasingly important as industry shifts from fee-for-service Digital health technology knowledge valuable for evolving care delivery models Population health management understanding helps in program development

Unique Aspects

Combination of specialty pharmacy and managed care expertise required
Remote work opportunity in traditionally office-based role
Strong focus on regional market development with national company backing

Career Growth

Typical progression to VP level within 3-5 years with demonstrated success in market expansion and contract optimization

Potential Next Roles

Vice President of Managed Care Chief Contract Officer Regional Vice President of Market Access Senior Director of Value-Based Programs

Company Overview

Pentec Health

Pentec Health is a specialized healthcare services provider focusing on complex pharmaceutical products and clinical services

Mid-sized specialty healthcare provider with strong regional presence and growing national footprint
Expanding national coverage with strategic focus on regional market development
Professional healthcare environment with emphasis on autonomous decision-making and results-driven performance
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