Operations Manager, Managed Care

Position Summary As Operations Manager, Managed Care, you will oversee day‑to‑day operations of the PHO’s governmental and managed care contracts, help position the network physicians, and manage the Silver Cross Health Connection in partnership with Essential Health Partners. Key Responsibilities Run day‑to‑day operations that enhance and expand revenue through commercial and governmental payer contracts. Implement and manage utilization management, quality and risk coding programs. Develop and execute gain‑sharing opportunities for network physicians. Communicate and build relationships with physicians, colleagues, and payer contacts. Position Silver Cross as a top performer and secure first‑to‑market opportunities. Develop and execute network strategy, including provider relations, credentialing, and network management of the PHO and EHP. Evaluate opportunities and recommend to physicians and senior management. Integrate pricing, contracting, and program development strategies to maximize volume and profitability. Maintain portfolio of contacts to ensure consistency and sustainability. Review contracts annually and execute management strategies for profitability. Provide tools to model and identify negotiation opportunities. Guide vendor partnerships of the PHO. Develop and support clinic and financial integration programs for network physicians. Ensure regulatory compliance for programs. Required Qualifications 10+ years of experience in healthcare at commercial payers, hospitals, or consulting firms. Bachelor’s degree in Business Administration or related field. Experience with local commercial payer healthcare executives. Significant experience in contracting and population health programs. Experience with Medicare Advantage and direct contracting with large employers preferred. Experience working with physician organizations. Work Shift Details Days: 05:00–14:00 Benefits Medical, Dental and Vision plans. Life Insurance. Flexible Spending Account. Other voluntary benefit plans. PTO and Sick time. 401(k) plan with match. Wellness program. Tuition reimbursement for eligible employees (registry employees are not eligible for Health and Welfare benefits). Pay range: $48.42 – $60.52 Silver Cross is an equal opportunity employer. #J-18808-Ljbffr 01 Silver Cross Hospital and Medical Centers