Vice President Managed Care

Beacon Health System is seeking a strategic and results-driven Vice President of Managed Care to lead the development, execution, and optimization of enterprise-wide payer strategy. This executive will oversee all managed care activities, including contract negotiation, value-based payment models, payer relationships, and network participation, with a focus on maximizing reimbursement, expanding market access, and advancing population health initiatives.

This role serves as a key member of the financial leadership team, partnering cross-functionally to align managed care strategies with system-wide growth, operational, and clinical objectives.

Key Responsibilities

Strategic Leadership & Payer Strategy

• Develop and execute short- and long-term managed care strategies aligned with organizational goals.
• Lead negotiations for commercial, Medicare Advantage, and Medicaid contracts to optimize reimbursement rates and value-based incentives.
• Design and implement innovative payment models, including risk-based and alternative payment arrangements.
• Continuously evaluate contract performance, financial impact, and payer relationships to drive renegotiation and optimization.

Network & Partnership Development

• Oversee participation in managed care networks, ensuring competitive positioning and access.
• Lead direct-to-employer contracting strategies, including program development and employer engagement.
• Respond to and manage Requests for Proposals (RFPs) from employers, brokers, and payer organizations.

ACO & PHO Oversight

• Provide executive leadership for the Accountable Care Organization (ACO) and Physician Hospital Organization (PHO).
• Ensure alignment of ACO/PHO strategies with system goals, value-based care initiatives, and physician engagement.
• Collaborate closely with physician groups to strengthen network performance and integration.

Financial & Operational Management

• Develop and manage annual operating budgets for managed care functions.
• Monitor financial performance, ensuring alignment with revenue and cost objectives.
• Drive initiatives to improve payment rates, reduce risk exposure, and enhance overall financial sustainability.

Care Coordination & Credentialing

• Oversee system-wide care coordination strategies to support value-based care delivery.
• Ensure effective payer/provider credentialing processes across the health system.

Organizational Influence & Education

• Serve as a subject matter expert, educating executive leadership on managed care trends, risks, and opportunities.
• Partner with internal stakeholders across finance, operations, clinical leadership, and strategy.

Leadership Competencies

• Results Orientation: Delivers measurable outcomes in complex, high-stakes environments.
• Customer Focus: Builds strong relationships with payers, employers, and internal stakeholders.
• Trust & Integrity: Demonstrates credibility, transparency, and ethical leadership.
• Collaboration: Drives alignment across diverse teams and physician partners.
• Communication: Effectively translates complex concepts for executive and operational audiences.
• Agility: Adapts quickly to evolving healthcare and reimbursement landscapes.

Qualifications

Education

• Bachelor’s degree in Business, Economics, Healthcare Administration, or related field required
• Master’s degree (MBA, MHA, or related) strongly preferred

Experience

• 5–10+ years of progressive leadership experience in managed care within a health system or payer organization
• Proven success negotiating complex contracts across Commercial, Medicare Advantage, and Medicaid
• Demonstrated experience with value-based care models, ACOs, and risk arrangements
• Strong leadership experience managing teams and cross-functional initiatives

Core Competencies & Expertise

• Deep understanding of managed care structures (HMO, PPO, Medicare Advantage, Medicaid)
• Expertise in contract negotiation, reimbursement modeling, and financial analysis
• Knowledge of regulatory environments impacting healthcare and payer systems
• Experience with employer health plans and direct-to-employer strategies
• Strong analytical, strategic thinking, and problem-solving capabilities
• Excellent executive communication and stakeholder management skills

Work Environment

• Primarily office-based with periodic travel required

Our Mission & Culture

Mission: Deliver outstanding care, inspire health, and connect with heart

Values: Trust. Respect. Integrity. Compassion.

At Beacon Health System, leaders are expected to embody The Beacon Way by:

• Driving innovation
• Developing talent
• Advancing performance improvement
• Leading with accountability
• Leveraging data for decision-making
• Communicating with clarity and consistency