Manager, Managed Care Contracting & Operations

Job Overview At NorthBay Health, the Manager, Managed Care Services possesses operational management and negotiating skills. The leader is responsible for payer strategy, contracting, reimbursement, and communicating potential threats to NorthBay arising from insurance industry changes, while also negotiating contracts and overseeing claims processing operations. This role negotiates with healthcare insurance companies and oversees implementation, monitoring, and evaluation of hospital, physician, and ancillary managed care payer contractual arrangements to increase or retain market share. The Manager also negotiates, implements, and monitors subcontracts for the system’s capitated business and hospice program and oversees staff education on managed care topics. Primary Job Responsibilities Communicate changing landscape of payor network, pricing, consolidation and payment strategies. Suggest strategies for mitigating financial damage to NorthBay before payor implementation. Conduct payor contract negotiations under leadership oversight. Conduct or oversee subcontract negotiations. Manage operationalization and staff education of managed care contracts. Manage data collection and analysis. Oversee claim payment functions for hospital and medical group claims. Manage capitation reconciliation and stop loss functions. Qualifications Education Bachelor’s degree required. Experience Minimum 3 years experience in healthcare reimbursement mechanisms and contract negotiations. Prior experience in a managed care organization or department required. Skills Understanding of health insurance market, distribution channels, delivery systems, referral arrangements, and financial principles. Strategic and tactical thinking; strong writing, verbal, analytical skills; detail orientation; ability to meet deadlines and produce accurate work. Strong negotiator. Interpersonal Skills Demonstrates True North values: Nurture/Care, Own It, Respect Relationships, Build Trust, Hardwire Excellence. Entrepreneurial instinct; responsibility, initiative, decision‑making, organized work style, high energy, productivity, problem solving, learning, listening, integrity. Hours Based on business need. Compensation $130,000 – $150,000 plus variable incentive bonus. Maximum rate listed is commensurate with 20+ years of experience; offer based on years of experience. Benefits Medical, dental, vision insurance; life, disability, long‑term care coverage. Paid time off (vacation, sick leave, holidays, bereavement). 403(b) retirement plan with employer match. Education reimbursement for eligible roles; professional development and training. Employee Assistance Program; wellness programs; recognition programs; shift differentials; market‑based compensation review and increases. Remote Work Disclosure Primarily onsite; some roles may allow hybrid or remote work based on business needs. Remote work not supported in Washington, Ohio, Wyoming, North Dakota, Puerto Rico, U.S. Virgin Islands, or outside the U.S. #J-18808-Ljbffr