Director of Managed Care

About Rediminds

At RediMinds, we build AI-enabled systems that help complex industries operate better, faster, and more intelligently. Our work spans healthcare, legal, finance, government, and other high-impact domains where software quality, trust, and speed truly matter.

We are a growing, entrepreneurial team that values ownership, clarity, compassion, and technical excellence. We're looking for builders who want to grow with us, contribute meaningfully, and be part of a team creating real products with real-world impact.

RediMinds — building the future with people who care enough to get the details right.

RediMinds, Inc. is an Equal Opportunity Employer. We are committed to creating an inclusive environment for all employees and applicants and prohibit discrimination and harassment of any kind. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, age, national origin, disability, veteran status, or any other protected characteristic as outlined by federal, state, or local laws.

About the role

Director of Managed Care

Reports to: Chief Operating Officer
Level: Director
Industry: Workers’ Compensation

Position Summary

The 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. The Director is accountable for creating an integrated, compliant, and profitable managed care business.

What you'll do

1. Division Strategy & Launch Planning

• Develop the strategy, business plan, and phased roadmap for launching UR, MBR, NCM, and Networks.
• Determine launch sequencing, resource requirements, and build-versus-partner decisions for each service line.
• Define service models, pricing, quality standards, and revenue targets in partnership with executive leadership.
• Set milestones and success metrics, and report progress to the COO and executives.

2. Business Development & Revenue Growth

• Build the sales strategy and go-to-market approach, including integrated, bundled service offerings.
• Identify and close initial clients among employers, insurers, third-party administrators, and self-insured entities.
• Build the pipeline and sales materials, including proposals, RFP responses, pricing models, and contract negotiation.
• Establish a framework for demonstrating outcomes and ROI as data becomes available.
• Represent the company at industry events, conferences, and client and prospect meetings.

3. Utilization Review Buildout

• Design the UR program, including policies, procedures, and required UR plan documentation under California requirements.
• Participate in URAC accreditation efforts.
• Establish decision standards, evidence-based guidelines, turnaround benchmarks, and documentation requirements.
• Recruit clinical reviewers and physician advisors, and build quality oversight and audit readiness.

4. Medical Bill Review Buildout

• Design the MBR program, including fee schedule application, coding review, and appeals or dispute processes.
• Select and implement bill review technology or vendor partners.
• Establish accuracy, savings, and turnaround benchmarks and client reporting.

5. Nurse Case Management Buildout

• Design the NCM program, including case management standards, caseload guidelines, pricing, and clinical quality oversight.
• Recruit and onboard licensed clinical staff, ensuring practice within licensure and regulatory requirements.
• Define outcome metrics, such as claim duration, medical spend, and return-to-work results.

6. Provider Network Buildout (HCO/MPN)

• Lead the strategy for HCO certification and MPN approval, including regulatory applications and supporting documentation.
• Build the provider network: recruitment, credentialing, contracting, and adequacy across required specialties and geographies.
• Establish provider data management and ongoing regulatory filing processes.

7. Regulatory Compliance Infrastructure

• Design compliance frameworks, policies, and controls for all service lines before launch.
• Build monitoring, reporting, and audit-readiness processes, and track regulatory changes.
• Communicate material compliance risks and recommended actions to executive leadership.

8. Client Onboarding & Relationship Management

• Design the client onboarding process across service lines.
• Serve as the senior contact for early clients and set service expectations for transparency and responsiveness.
• Lead account reviews and identify opportunities to expand services within each account.

9. Team Building & Leadership

• Define the organizational structure and staffing plan, then recruit, hire, and develop managers and staff across all service lines.
• Set performance expectations, accountability standards, and a culture of transparency and continuous improvement.
• Phase hiring to match client growth and revenue.

10. Systems, Process & Technology Build

• Select and implement the platforms needed across UR, MBR, NCM, and Networks, with attention to integration and data integrity.
• Design standardized workflows, quality controls, and client-facing reporting and analytics from the start.
• Partner with IT and external vendors on configuration and implementation.

11. Financial Stewardship

• In collaboration with executive leadership, build and manage the division’s startup budget, staffing plan, and vendor spend.
• Own P&L accountability as services launch and scale, and define the path to profitability.
• Assess the financial implications of service models, pricing, and investments, and make recommendations to executive leadership.

12. Executive Collaboration & Strategy

• Act as a strategic partner to the COO and executive team on growth, risk, and market positioning.
• Collaborate with compliance, finance, technology, and client services on cross-functional planning.
• Identify market trends, emerging risks, and investment needs.