Southwest Michigan Behavioral Health • Executive Leadership • Hybrid
Reports To | Chief Executive Officer |
FLSA Status | Exempt |
Compensation | Commensurate with experience |
THE CHIEF MANAGED CARE OFFICER OPPORTUNITY
As Chief Managed Care Officer, you'll lead SWMBH's managed care operations as a key member of the executive leadership team — overseeing program integrity, compliance, customer services, and provider network management across the region.
WHAT THE CHIEF MANAGED CARE OFFICER WILL OWN
- Executive strategy for program integrity, compliance, customer services & provider network management
- Regulatory and contractual compliance across Medicaid managed care requirements
- Direct oversight of Program Integrity, SIU, and Customer Services leadership
- Provider network contracting, negotiation, and performance
- Advising the CEO on managed care risk and organizational strategy
WHAT THE CHIEF MANAGED CARE OFFICER NEEDS TO BRING
- Bachelor's required (JD/Master's preferred) in a related field
- 8+ years progressive leadership in managed care, Medicaid, or healthcare compliance
- Deep knowledge of PIHP operations and complex contract terms
- Proven track record leading cross-functional teams through change
Keep scrolling for the full position details, or jump straight to applying below.
◆ ◆ ◆
CHIEF MANAGED CARE OFFICER — FULL POSITION DETAILS
The Chief Managed Care Officer reports to the CEO and serves as a key member of the senior leadership team, providing executive oversight of program integrity and compliance, customer services, and provider network management. As Chief Managed Care Officer, this role ensures the organization meets federal and state regulations, managed care rules, and contractual requirements — driving access, accountability, quality, and transparency across the region's PIHP managed care responsibilities.
CHIEF MANAGED CARE OFFICER DUTIES & RESPONSIBILITIES
Executive Leadership & Regional Alignment
- Sets strategic direction for managed care functions in alignment with agency mission and federal/contractual obligations
- Advises the CEO and executive leadership on managed care operations, risk, and improvement opportunities
- Collaborates with regional CMHSP partners to ensure delegated managed care functions run effectively
- Interprets contract language, Managed Care Regulations, and the Administrative Code for agency-wide application
- Leads cross-functional planning and implementation for regulatory changes, audits, and corrective actions
- Ensures required MDHHS and EQRO reporting/audit standards are met
Program Integrity & Compliance
- Provides executive oversight of program integrity and compliance functions
- Oversees the Director of Program Integrity & SIU and the Compliance Officer
- Oversees monitoring, reporting, corrective action follow-up, and audit readiness
- Partners with legal counsel, regulators, and delegated entities to resolve compliance issues
- Maintains policies, workflows, and records that support regulatory compliance
Customer Services
- Provides executive oversight ensuring timely, accurate, and culturally responsive customer service
- Ensures effective access for inquiries, complaints, grievances, and appeals
- Supports the Fair Hearing Process and escalation of complex fair hearing cases
- Monitors customer service data and trends to inform quality improvement
- Promotes a customer-focused, transparent, and continuously improving culture
Provider Network Management
- Provides executive oversight ensuring an accessible, qualified, and compliant provider network
- Oversees provider contracting, credentialing interfaces, and contract compliance
- Negotiates and operationalizes complex provider agreements
- Monitors provider performance, access standards, and network capacity
- Leads strategies to strengthen provider relationships and resolve network issues
CHIEF MANAGED CARE OFFICER ESSENTIAL FUNCTIONS
- Provides strategic vision and executive oversight of program integrity, customer services, and provider network management
- Ensures managed care operations comply with federal/state regulations, MDHHS contracts, and accreditation standards
- Facilitates cross-department collaboration on new models and service improvements
- Leads monitoring, reporting, risk identification, and corrective action processes
CHIEF MANAGED CARE OFFICER LEADERSHIP RESPONSIBILITIES
- Supervises assigned managed care functions; provides leadership, coaching, and accountability
- Works collaboratively with the CEO and executive team on compliance and continuous improvement
CHIEF MANAGED CARE OFFICER QUALIFICATIONS
- Bachelor's in Business Administration, Public Health, Social Work, Law, Public Administration, or related field required; Juris Doctor or Master's strongly preferred
- 8+ years of progressively responsible leadership experience in managed care, behavioral health, Medicaid, healthcare administration, compliance, or provider network operations
- Demonstrated knowledge of Medicaid managed care requirements, PIHP operations, and complex contract terms
- Ability to negotiate, interpret, and operationalize complex contracts into policy and practice
- Proven ability to lead cross-functional teams and organizational change
- Strong analytical, communication, and relationship-building skills; proficient in Microsoft Office 365
- Commitment to culturally competent, trauma-informed, person-centered practices
WORKING ENVIRONMENT & PHYSICAL REQUIREMENTS
- Primarily an office environment; frequent sitting, standing, and walking
- Occasional local/regional travel for conferences and related events
- Ability to occasionally lift up to 20 lbs
HOW TO APPLY
Ready to lead SWMBH's managed care operations as our next Chief Managed Care Officer? Apply online at www.swmbh.org. Emailed resumes will not be accepted.
Compensation details: 140000-199000 Yearly Salary
PIe3f9164bcbfc-38265-41708391