Senior Vice President (SVP) of Managed Care | PAM Health Corporate

Overview

The Senior Vice President (SVP) of Managed Care is responsible for providing strategic leadership and oversight of the organization's managed care and payor engagement strategy across a multi-state network of Inpatient Rehabilitation Facilities (IRFs), Long-Term Acute Care Hospitals (LTACHs), outpatient programs, home health agencies, physician enterprises, and behavioral health hospitals. This executive leads enterprise-wide contracting, reimbursement optimization, and payor partnerships while developing scalable managed care strategies that support organizational growth, regulatory compliance, patient access, operational performance, and financial success. The SVP collaborates closely with Executive Leadership, Operations, Finance, Revenue Cycle, Clinical Leadership, and Admissions to align managed care initiatives with the organization's strategic objectives.

 

The SVP provides leadership to the Managed Care team, including Regional Directors of Managed Care, and is responsible for directing departmental priorities, contract negotiations, and implementation of managed care policies across the organization. This role oversees relationships with Commercial, Medicare Advantage, Managed Medicaid, ACA Exchange, Medicare ACO, TRICARE, VA Community Care Network (VA CCN), Workers' Compensation, and other governmental payors, while also leading value-based care initiatives and Supplemental Directed Payment Programs (DPP) across the organization's 17-state footprint. This position reports directly to the Senior Executive Vice President, Chief Government Relations Officer & Senior Executive Advisor.

Responsibilities

• Lead enterprise managed care contracting strategy, including negotiation, rate optimization, and payor relationship management across commercial, government, and value-based programs.
• Oversee development, review, and execution of managed care agreements, ensuring alignment with organizational, financial, and regulatory objectives
• Collaborate with operations, finance, admissions, and revenue cycle teams to improve reimbursement, reduce denials, and optimize payor performance
• Provide strategic direction and leadership to managed care team, including Regional Directors, ensuring effective execution of priorities and initiatives
• Build and maintain relationships with national, regional, and local payors to expand market access and strengthen partnerships
• Identify opportunities for growth, contract expansion, and revenue improvement across new and existing markets and service lines
• Partner with executive leadership to assess risks, trends, and opportunities in managed care and reimbursement environments
• Monitor industry changes, CMS regulations, and payor policies to ensure compliance and informed strategic decision-making
• Support financial performance through contract analysis, reimbursement strategies, and collaboration on revenue cycle initiatives
• Ensure compliance with regulatory requirements and managed care contracts
• Monitor CMS, healthcare laws, and reimbursement changes
• Oversee adherence to contract terms across multi-state operations
• Partner with Legal, Compliance, and Revenue Cycle to mitigate risk

 

II. Leadership

· Inclusiveness: Promotes cooperation, fairness and equity; shows respect for people and their differences; works to understand perspectives of others; demonstrates empathy; brings out the best in others and in his/her team

· Managing Staff: Coaches, evaluates, develops, and inspires staff; sets expectations; recognizes achievements

· Stewardship and Resource Management: Demonstrates accountability and sound judgment in managing company resources; appropriate understanding of confidentiality and company values; adheres to and supports company policies, procedures and safety guidelines

· Problem-Solving: Identifies problems and involves others in seeking solutions; conducts appropriate analysis and searches for best solutions; effectively and efficiently implements appropriate responses to correct problems; responds promptly and effectively to new challenges

· Decision-Making: Makes clear, consistent decisions; acts with integrity in all decisions; distinguishes relevant from irrelevant information; makes timely, appropriate decisions.

· Strategic Planning and Organizing: Understands company vision and aligns priorities accordingly; measures outcomes; uses feedback to redirect as required; evaluates alternatives; appropriately organizes complex issues to desirable resolution

· Communication: Connects with peers, subordinate employees and all customers; actively listens; clearly and effectively shares information; demonstrates effective oral and written communication skills; negotiates effectively.

· Quality Improvement: Strives for efficient, effective, high-quality performance in self and in the department; delivers timely and accurate results; resilient when responding to matters that are challenging; takes initiative to make improvements

· Leadership: Motivates others; accepts responsibility; maintains high morale in department; develops trust and credibility; expects honest and ethical behavior of self and staff

· Teamwork: Encourages cooperation and collaboration; builds effective teams; works in partnership with others; is flexible; responsive to the needs of others

· Development: Maintains up-to-date skills through involvement with professional organizations and/or continuing education

 

II. Customer Service

· Maintains the highest level of customer service via courtesy, compassion and positive communication.

· Promotes the mission and vision of PAM Health within the work environment and the community.

· Respects dignity and confidentiality by adherence to all applicable policies and procedures.

 

III. Health and Safety

· Works in a manner that promotes safety; wears clothing appropriate to the performance of the job.

· Participates in OSHA required training.

· Follows universal precautions as appropriate for position; complies with Employee Health requirements for continued employment.

· Reports unsafe practices to management.

· Knows own role in case of an emergency.

Qualifications

Education and Training:  Bachelor’s degree in Healthcare Administration, Business, Finance, or related field required. Master’s degree (MBA, MHA, or similar) strongly preferred 

Experience:    

• 10+ years of progressive leadership experience in managed care, payor contracting, Utilization Review, or claims or healthcare administration
• Significant experience within post-acute care, hospital systems, or healthcare services as well as Professional Service contracting
• Experience in working with Health Plans in network contracting role or claim services a distinct plus
• Proven success in contract negotiation, payor strategy, and revenue optimization
• Expertise in all forms of reimbursement such as per diems, episode pricing, capitation, O/P Fee Schedules, RBRVS for professional services

Knowledge, Skills, and Abilities:

 

• 10+ years of progressive leadership experience in managed care, payor contracting, or healthcare administration
• Significant experience within post-acute care, including IRF and LTAC settings strongly preferred
• Experience working within multi-state healthcare organizations with an understanding of varying regulatory and reimbursement environments

About PAM Health

PAM HEALTH (PAM) based in Enola, Pennsylvania, provides specialty healthcare services through more than 80 locations, as well as wound clinics and outpatient physical therapy locations, in 17 states. PAM Health is committed to providing high-quality patient care and outstanding customer service, coupled with the loyalty and dedication of highly trained staff, to be the most trusted source for post-acute services in every community it serves. Its mission is to serve people by providing compassionate, expert care, and to support recovery through education and research. Joining our PAMily allows you to work in a collaborative environment with colleagues and leadership with exposure to a variety of patient care levels. Aside from our competitive pay, generous paid benefit time, and excellent insurance options, you will also have opportunities for professional growth through our Education Advancement Program. We are excited to learn more about you and hope that you consider joining us on a shared mission to improve the lives of others by being an integral part of our We Care Program. Please take a moment to visit us online at www.PAMHealth.com for a comprehensive look at how we're able to positively impact our local communities.

 

PAM Health does not discriminate and does not permit discrimination, including, without limitation, bullying, abuse or harassment, on the basis of actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or HIV status, or based on association with another person on account of that person's actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or HIV status.