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Portage, Michigan
Southwest Michigan Behavioral Health
Chief Managed Care Officer
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 managementRegulatory and contractual compliance across Medicaid managed care requirementsDirect oversight of Program Integrity, SIU, and Customer Services leadershipProvider network contracting, negotiation, and performanceAdvising 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 field8+ years progressive leadership in managed care, Medicaid, or healthcare complianceDeep knowledge of PIHP operations and complex contract termsProven 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 obligationsAdvises the CEO and executive leadership on managed care operations, risk, and improvement opportunitiesCollaborates with regional CMHSP partners to ensure delegated managed care functions run effectivelyInterprets contract language, Managed Care Regulations, and the Administrative Code for agency-wide applicationLeads cross-functional planning and implementation for regulatory changes, audits, and corrective actionsEnsures required MDHHS and EQRO reporting/audit standards are met
Program Integrity & Compliance
Provides executive oversight of program integrity and compliance functionsOversees the Director of Program Integrity & SIU and the Compliance OfficerOversees monitoring, reporting, corrective action follow-up, and audit readinessPartners with legal counsel, regulators, and delegated entities to resolve compliance issuesMaintains policies, workflows, and records that support regulatory compliance
Customer Services
Provides executive oversight ensuring timely, accurate, and culturally responsive customer serviceEnsures effective access for inquiries, complaints, grievances, and appealsSupports the Fair Hearing Process and escalation of complex fair hearing casesMonitors customer service data and trends to inform quality improvementPromotes a customer-focused, transparent, and continuously improving culture
Provider Network Management
Provides executive oversight ensuring an accessible, qualified, and compliant provider networkOversees provider contracting, credentialing interfaces, and contract complianceNegotiates and operationalizes complex provider agreementsMonitors provider performance, access standards, and network capacityLeads 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 managementEnsures managed care operations comply with federal/state regulations, MDHHS contracts, and accreditation standardsFacilitates cross-department collaboration on new models and service improvementsLeads monitoring, reporting, risk identification, and corrective action processes
CHIEF MANAGED CARE OFFICER LEADERSHIP RESPONSIBILITIES
Supervises assigned managed care functions; provides leadership, coaching, and accountabilityWorks 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 preferred8+ years of progressively responsible leadership experience in managed care, behavioral health, Medicaid, healthcare administration, compliance, or provider network operationsDemonstrated knowledge of Medicaid managed care requirements, PIHP operations, and complex contract termsAbility to negotiate, interpret, and operationalize complex contracts into policy and practiceProven ability to lead cross-functional teams and organizational changeStrong analytical, communication, and relationship-building skills; proficient in Microsoft Office 365Commitment to culturally competent, trauma-informed, person-centered practices
WORKING ENVIRONMENT & PHYSICAL REQUIREMENTS
Primarily an office environment; frequent sitting, standing, and walkingOccasional local/regional travel for conferences and related eventsAbility 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 . Emailed resumes will not be accepted.
Compensation details: 00 Yearly Salary
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