Manager, Managed Care Services (Hybrid/On-Site)
About The Position
The Manager of Managed Care Services at Northbay Health is responsible for operational management and negotiating skills within the healthcare insurance industry. This role involves communicating potential threats from industry changes, managing contract negotiations, and overseeing operations related to claims processing. The Manager negotiates with healthcare insurance companies and manages the implementation, monitoring, and evaluation of contractual arrangements for hospitals, physicians, and ancillary providers to increase or retain market share. Additionally, the position oversees the negotiation, implementation, and monitoring of subcontracts for the system’s capitated business and hospice program. A key responsibility includes overseeing staff education on managed care topics, contract implementation, and monitoring.
Requirements
- Bachelor’s degree required or minimum 8 years of experience in managed care services demonstrating leadership qualities.
- Minimum 3 years of experience required in healthcare reimbursement mechanisms and contract negotiations.
- Prior experience in a managed care organization or department required.
- Understands the health insurance market and distribution channels, the healthcare delivery system, referral arrangements and financial principles.
- Capability to think strategically as well as tactically.
- Good writing and verbal skills.
- Analytical skills (quantitative and mathematical skills strongly preferred).
- Ability to work and speak openly with people throughout the organization.
- An orientation to detail, along with the ability to manage details.
- Ability to meet deadlines and ability to produce accurate work.
- Must be a strong negotiator.
- Demonstrates the True North values: Nurture/Care, Own It, Respect Relationships, Build Trust and Hardwire Excellence.
- Has an entrepreneurial instinct.
- A sense of responsibility to meet the needs of managers in the organization around contracting and managed care issues.
- A high comfort level with taking initiative, making decisions and handling responsibility.
- An organized work style.
- High energy and productivity.
- A problem-solving orientation.
- A comfort level with learning new ideas.
- Good listener.
- Strong integrity.
Responsibilities
- Communicating potential threats to Northbay resulting from changes in the insurance industry.
- Contract negotiations with healthcare insurance companies.
- Overseeing the implementation, monitoring, and evaluation of hospital, physician, and ancillary managed care payor contractual arrangements.
- Overseeing the negotiation, implementation, and ongoing monitoring of subcontracts for the system’s capitated business and for the hospice program.
- Overseeing staff education on managed care topics and contract implementation and monitoring.
Benefits
- medical, dental, and vision insurance
- life, disability, and long-term care coverage
- paid time off including vacation, sick leave, holidays, and bereavement
- a 403(b) retirement plan with employer match
- education reimbursement for eligible roles
- professional development and training programs
- Employee Assistance Program
- wellness programs
- recognition programs
- shift differentials
- market-based compensation review and increases subject to approval and organizational performance
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What This Job Offers
Job Type
Full-time
Career Level
Manager
