Manager, Managed Care Contracting & Operations

Job Description

Job Description

At NorthBay Health The Manager, Managed Care Services possesses both operational management and negotiating skills. The leader is responsible for payor strategy, contracting, reimbursement and communicating potential threats to NorthBay resulting from changes in the insurance industry, while also being responsible for contract negotiations and the operations associated with claims processing. This person negotiates for NorthBay with healthcare insurance companies and oversees the implementation, monitoring, and evaluation of hospital, physician, and ancillary managed care payor contractual arrangements with the potential to increase or retain market share. The Manager also oversees the negotiation, implementation, and ongoing monitoring of subcontracts for the system’s capitated business and for the hospice program. This position is responsible for overseeing staff education on managed care topics and contract implementation and monitoring.

At NorthBay Health, our vision is to be the trusted healthcare partner of choice for the communities we serve. We are dedicated to improving the well-being of our community by providing accessible, high-quality care to all who need it. Every member of our team plays a vital role in delivering compassionate and effective healthcare solutions. We invite you to join us in our mission to ensure that every patient and family member feels valued, respected, and cared for throughout their healthcare journey.

• Communicate the changing landscape of payor network, pricing, consolidation and payment strategies.
• Suggest strategies for mitigating financial damage to NorthBay in advance of the implementation of these strategies by payors.
• Conduct Payor Contract Negotiations under oversight of leadership
• Conduct or oversee Subcontract Negotiations.
• Manage or Oversee Operationalization and staff education of managed care contracts and related topics.
• Manage or Oversee Data Collection and Analysis.
• Oversee the management of the claim’s payment function for hospital and medical group claims.
• Manage or Oversee capitation reconciliation and stop loss functions.