Role OverviewThe Director of Managed Care will build RediMinds' managed care division from the ground up, including Utilization Review (UR), Medical Bill Review (MBR), Nurse Case Management (NCM), and Provider Networks (HCO/MPN). The Director sets the strategy, sequences the launch of each service line, builds the team and infrastructure, and wins the first clients.
What You Will Do
Develop the strategy, business plan, and phased roadmap for launching UR, MBR, NCM, and Networks. Build the sales strategy and go-to-market approach, including integrated, bundled service offerings. Design the UR program, including policies, procedures, and required UR plan documentation under California requirements.
Why It Might Be a Fit
The Director is accountable for creating an integrated, compliant, and profitable managed care business. The Director will represent the company at industry events, conferences, and client and prospect meetings.
Requirements
- 10+ years of experience in managed care, utilization review, medical bill review, nurse case management, and provider networks
- Proven track record of building and leading high-performing teams
- Strong business development and sales skills
- Ability to design and implement compliance frameworks, policies, and controls for all service lines
- Experience with regulatory compliance and audit-readiness processes
Benefits
- Opportunities for professional growth and development
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