Director, Managed Care

Atlantic Health System•Morristown, NJ

1d•Onsite

About The Position

The Director of Managed Care serves as the leader responsible for the strategy, execution, and performance of all managed care activities across both fee‑for‑service (FFS) and value‑based care (VBC) arrangements. Reporting to the Vice President of Insurance Networks, this role oversees the teams responsible for contract negotiations, payer relations, medical economics, reimbursement modeling, and value‑based program performance. The Director leads the development, negotiation, implementation, and monitoring of all hospital, physician, ambulatory, and ancillary managed care agreements. This includes ensuring accurate contract configuration, optimizing reimbursement, and driving payer accountability. The role also provides executive oversight of the organization’s value‑based payment portfolio—including shared savings, downside risk, bundled payments, and capitation—ensuring the system achieves quality, cost, and financial targets. This leader collaborates closely with Finance, Revenue Cycle, Population Health, Clinical Operations, and site CFOs to align contracting strategy with organizational goals, support growth initiatives, and develop the annual hospital revenue budget. The Director is a key architect of the system’s managed care strategy and a central driver of enterprise‑wide financial performance.

Requirements

Experience leading managed care contracting, payer relations, medical economics, and value-based program performance.
Experience with contract negotiations, payer relations, medical economics, reimbursement modeling, and value-based program performance.
Experience in developing, negotiating, implementing, and monitoring managed care agreements.
Experience ensuring accurate contract configuration, optimizing reimbursement, and driving payer accountability.
Experience providing executive oversight of value-based payment portfolios (shared savings, downside risk, bundled payments, capitation).
Experience collaborating with Finance, Revenue Cycle, Population Health, Clinical Operations, and site CFOs.
Experience developing annual hospital revenue budgets.
Experience in developing and executing contracting strategies.
Experience building and maintaining strong payer relationships.
Experience overseeing credentialing, billing, reimbursement, and payer policy interpretation.
Experience directing teams responsible for FFS and VBC analytics, modeling, and performance monitoring.
Experience ensuring accurate pricing of claims through Epic contract configuration.
Experience partnering with Revenue Cycle to optimize contractual performance metrics.
Experience leading the development, valuation, and tracking of value-based programs.
Experience monitoring payer performance, utilization trends, and reimbursement outcomes.
Experience guiding bundled payment programs and participating in risk-based program development.
Experience providing strategic oversight of medical economics functions.
Experience directing analytical resources to evaluate contract proposals and support negotiation strategy.
Experience reviewing and approving analyses related to payer policy changes, regulatory updates, and reimbursement shifts.
Experience overseeing utilization and payment databases.
Experience monitoring cash realization and developing strategies to address denials, underpayments, and payment deprivation.
Experience overseeing network adequacy and access standards for self-insured employee health plans.
Experience negotiating reimbursement terms with community providers.
Experience developing standing rate agreements.
Experience leading, mentoring, and developing teams.
Experience fostering a culture of collaboration, transparency, and innovation.
Experience communicating complex concepts clearly to executives, physicians, and cross-functional partners.
Experience representing Managed Care in system-wide initiatives, interdisciplinary workgroups, and strategic planning efforts.

Responsibilities

Provide oversight for all managed care contracting across the system, including hospitals, physician enterprise, ambulatory centers, ancillaries, and value‑based arrangements.
Develop and execute contracting strategies that anticipate market shifts, payer policy changes, and regulatory developments.
Lead the creation of innovative contract structures that support system‑wide financial, operational, and quality goals.
Build and maintain strong payer relationships, ensuring transparency, accountability, and alignment with organizational priorities.
Oversee credentialing, billing, reimbursement, and payer policy interpretation in collaboration with internal stakeholders.
Direct the teams responsible for FFS and VBC analytics, modeling, and performance monitoring.
Ensure accurate pricing of claims through Epic contract configuration and partner with Revenue Cycle to optimize contractual performance metrics.
Lead the development, valuation, and tracking of all value‑based programs, including shared savings, bundled payments, downside risk, and capitation.
Monitor payer performance, utilization trends, and reimbursement outcomes to identify opportunities for improvement and risk mitigation.
Guide the organization’s strategy for bundled payment programs and participate in system‑wide risk‑based program development.
Provide strategic oversight of medical economics functions, ensuring accurate modeling, forecasting, and financial impact analyses.
Direct analytical resources to evaluate alternative contract proposals, quantify financial implications, and support negotiation strategy.
Review and approve analyses related to payer policy changes, regulatory updates, and reimbursement shifts.
Oversee the maintenance of detailed utilization and payment databases, ensuring accurate benchmarking and performance tracking.
Monitor cash realization relative to contract value and develop strategies to address denials, underpayments, and payment deprivation.
Oversee network adequacy and access standards for the system’s self‑insured employee health plan.
Negotiate reimbursement terms with community providers to support Tier 1 network growth and cost containment.
Develop standing rate agreements that enable bundled and episodic risk programs.
Lead, mentor, and develop teams across contracting, payer relations, and medical economics.
Foster a culture of collaboration, transparency, and innovation.
Communicate complex concepts clearly to executives, physicians, and cross‑functional partners.
Represent Managed Care in system‑wide initiatives, interdisciplinary workgroups, and strategic planning efforts.

Benefits

Medical, Dental, Vision, Prescription Coverage
Life & AD&D Insurance
Short-Term and Long-Term Disability
403(b) Retirement Plan with Employer match and additional non-elective contribution
PTO & Paid Sick Leave
Tuition Assistance, Advancement & Academic Advising
Parental, Adoption, Surrogacy Leave
Backup and On-Site Childcare
Well-Being Rewards
Employee Assistance Program (EAP)
Fertility Benefits, Healthy Pregnancy Program
Flexible Spending & Commuter Accounts
Pet, Home & Auto, Identity Theft and Legal Insurance