Senior Director Revenue Cycle

Wilshire hires only the brightest and most experienced professionals in the healthcare revenue cycle management industry.  Wilshire will take the time to get know you and your employment history.  We will then place you in a role that will lead to a path of career success.  

About The Wilshire Group 

The Wilshire Group, a renowned boutique consulting firm in Los Angeles, specializes in revenue cycle optimization and fostering effective collaboration between operational and IT facets.  With a robust track record of aiding over 100 healthcare systems nationwide, our team thrives on professionalism, efficiency, and adaptability.

Our core values- professionalism, efficiency, and flexibility- underscore our commitment to creating an inclusive and dynamic workplace.  We embrace diverse narratives and believe in offering opportunities to exceptional individuals who bring their best to the table.

We are currently offering a contracted interim position at one of US News Best Hospitals 2022-23.  This position caters to top performers seeking a professional environment that acknowledges and values their dedication and proficiency.  While this role doesn’t offer benefits, it presents an opportunity to work within an organization that encourages talented individuals to surpass conventional boundaries.

Join us at The Wilshire Group, a place where talented professionals find a home to showcase their skills and contribute meaningfully to the healthcare landscape.

Why Wilshire? Employee Testimonial

“The number of RCM subject matter experts I get to work with each day is unreal.  Working alongside and as part of this team to help shape the RCM space is exciting.”-Patti Consolver, Director of Business Development 

This is a contracted position for 6+ months.   Equivalent to $95-$100 per hour.

Job Title: Senior Director, Managed Care Operations
Reports to: Chief Financial Officer or Executive Leadership
Location: San Diego, CA (On-Site)

Position Summary

The Senior Director of Managed Care Operations is responsible for the strategic planning, organization, and execution of managed care claims operations for a healthcare system that includes hospitals and affiliated medical groups. This role oversees operations related to managed care enrollment for over 325,000 lives, claims processing, encounter and HCC reporting, contract reimbursement, denial management, business analytics, budgeting, and operational support services.

The position plays a critical leadership role in transforming processes, improving financial performance, and aligning systems to ensure accuracy, efficiency, and compliance. The Senior Director collaborates with cross-functional teams including revenue cycle, legal, compliance, information systems, and health plan partners to ensure effective and integrated operations.

Key Responsibilities

Strategic & Operational Leadership

• Directs and oversees managed care claims operations, including claims adjudication, enrollment, and reporting functions.

• Develops and implements operational strategies aligned with organizational goals and regulatory requirements.

• Leads process improvement initiatives to enhance service delivery, reduce costs, and improve performance outcomes.

Claims & Revenue Operations

• Ensures timely and accurate processing of claims and enrollment data.

• Oversees contract reimbursement and denial management processes.

• Manages compliance with industry regulations and internal policies.

• Leads system conversions, upgrades, and technology enhancements related to claims operations.

Financial Management

• Develops and monitors departmental budgets and key financial metrics.

• Reviews financial reports for accuracy, identifies trends, and implements corrective actions.

• Provides executive consultation on financial implications of payer programs and policy changes.

Compliance & Quality Assurance

• Maintains up-to-date claims policies and internal controls.

• Ensures compliance with federal, state, and payer requirements.

• Implements remediation plans to address identified compliance gaps.

Program & Systems Development

• Champions the development of new claims and reporting tools to enhance operational performance.

• Prioritizes information system initiatives to support managed care operations.

• Partners with technology teams to drive continuous improvements and data integrity.

Leadership & Team Development

• Provides strategic leadership and mentoring to managers and staff.

• Fosters a culture of accountability, performance, and continuous learning.

• Builds strong partnerships with internal and external stakeholders to support organizational success.

Qualifications

Education:

• Bachelor’s degree in Business Administration, Healthcare Administration, Finance, Accounting, or a related field (required).

• Master’s degree (preferred).

Experience:

• Minimum of 10 years of progressive experience in managed care operations, revenue cycle, or healthcare finance.

• Strong background in claims processing, managed care contracting, financial performance management, and team leadership.

• Proven success leading large teams and complex, cross-functional projects in a healthcare setting.

Skills:

• Deep knowledge of managed care principles, payer relations, and healthcare reimbursement methodologies.

• Demonstrated ability to lead change, drive operational improvements, and manage performance through metrics.

• Strong communication, collaboration, and problem-solving skills.

Wilshire is honored that you have taken the time to review/apply to our open position.  We will now take the time to review your experience and be in touch with you soon.