Vice President, Managed Care and Health Plan Integration
About The Position
At NorthBay Health, we are a rapidly expanding, physician-guided, integrated health system operating across multiple counties with multiple hospitals, 300+ employed/providers-aligned physicians, and significant ownership in a successful, growth-oriented regional health insurance plan. The health plan is a strategic differentiator that drives alignment, value-based performance, and margin. SUMMARY This is an executive role responsible for accelerating the profitable growth of our owned health plan, deepening payer relationships, and embedding the health system and health plan into the fabric of every community we serve. This is a highly visible, enterprise-wide leadership position that combines traditional managed care contracting expertise with modern population-health strategy, product design, marketing, and community partnership development. This is a rare opportunity for a strategic, growth-oriented managed care executive to take a visible role in building one of the fastest-growing integrated health system/health plan combinations in the country.
Requirements
- Bachelor’s degree required; Master’s (MHA, MBA, MPH) strongly preferred.
- Ten to fifteen (10–15+) years progressive managed care leadership experience within a health system, health plan, or large medical group.
- Proven track record of growing a health insurance plan or major product line (membership and profitability).
- Deep expertise in value-based care contracting, payer negotiations, and risk arrangement design.
- Demonstrated success in employer sales, community partnership development, and brand-building in competitive markets.
- Experience with Medicare Advantage, Medicaid managed care, and commercial products.
- Exceptional communication skills with experience presenting to boards, large employers, and community stakeholders.
- Interpersonal Skills: Demonstrates the True North values. The True North values are a set of value-based behaviors that are to be consistently demonstrated and role modeled by all employees that work at NorthBay Health. The True North values principles consist of Nurture/Care, Own It, Respect Relationships, Build Trust and Hardwire Excellence.
- A successful leader will live and serve in the geographic area of NorthBay Health.
- Full time, management exempt.
- Hours will vary according to work demands.
- Willingness to travel 30–40% across current and expansion markets.
- Primary work location is corporate headquarters in Fairfield
Nice To Haves
- Current or prior P&L responsibility for a health plan or major business unit preferred.
- Experience launching narrow-network or direct-to-employer products preferred.
- Existing relationships with national and regional payers in our footprint preferred.
Responsibilities
- Health Plan Growth & Profitability Lead/support membership growth strategy targeting commercial, Medicare MediCal/Partnership lines of business (goal: align with ANS growth strategy targets).
- Oversee product design, pricing, network strategy, and benefit configuration in collaboration with actuarial, clinical, and sales teams.
- Achieve and exceed annual medical loss ratio (MLR), administrative expense, and margin targets.
- Managed Care Contracting & Payer Strategy Negotiate and manage all external payer contracts (national, regional, and local plans) to maximize system reimbursement while protecting health plan competitiveness.
- Serve as the enterprise expert on value-based contracting, bundled payments, and risk arrangements.
- Community Awareness, Brand Integration & Market Expansion Develop and execute a comprehensive community engagement and brand-integration strategy in conjunction with the Marketing Communication Team so that the health system and health plan are recognized as the preferred, local choice in every new and existing market.
- Build strategic partnerships with large employers, chambers of commerce, school systems, FQHCs, faith-based organizations, and municipal governments.
- Lead employer direct-to-employer (DTE) sales and narrow-network product launches.
- Clinical & Financial Integration Partner with Population Health, clinical leadership, and medical group presidents to hardwire clinical programs (chronic disease management, transitional care, behavioral health integration) that simultaneously improve health plan STAR/HEDIS performance and reduce system total cost of care.
- Drive shared savings and risk-revenue performance across Medicare ACOs, MSSP, and commercial risk contracts.
- Leadership & Team Development Build and lead a lean, high-performing team (contracting, network development, provider relations, community engagement, health plan sales/support).
- Serve as a key member of the system leadership team and prepare regular updates for the system board of directors.
Benefits
- This position is bonus eligible.
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What This Job Offers
Job Type
Full-time
Career Level
Executive
