Manager, Managed Care Contracting and Operations (Hybrid/On-Site)

Manager, Managed Care Contracting and Operations

*** This role is Hybrid, working on-site 3 days a week in Fairfield, CA***

At Northbay Health, the Manager, Managed Care Contracting and Operations possesses strong operational management and negotiating skills. The Manager negotiates for Northbay with healthcare insurance companies and oversees the implementation, monitoring, and evaluation of hospital, physician, and ancillary managed care payor contractual arrangements. The Manager also oversees the negotiation, implementation, and ongoing monitoring of subcontracts for the system's capitated business and for the hospice program.

Primary Responsibilities

• Lead negotiations for all system entities, including reimbursement, contract terms/language, renewals and value-based agreements.
• Manage and oversee Subcontract Negotiations.
• Lead Payer joint operations committees with the systems major health plan payors.
• Facilitate operational meetings to educate Northbay departments on new contracts, amendments and payor polices.
• Partner with Revenue Cycle, Legal, Network Development, Payment Integrity and Finance to ensure financially sound contracts and optimize Northbay contractual collections and A/R.
• Manage or Oversee Operationalization and staff education of managed care contracts and related topics.
• Analyze financial impact of contracts and terms using Experian or EPIC Reimbursement Contract Manager.
• Oversee the management of the claim's payment function for hospital and medical group claims.
• Manage or Oversee capitation reconciliation and stop loss functions.
• Manage contract language edits and facilitate legal department approvals

Qualifications

1. Education. Bachelor's degree required.
2. Experience: Minimum 3 years of experience required in healthcare reimbursement mechanisms and contract negotiations. Prior experience in a managed care organization or department required. Prior experience with Medi-Cal, ACO, value-based contracting is required. Prior experience with managing staff is preferred but not required.
3. Skills: Understands the health insurance market and distribution channels, the healthcare delivery system, referral arrangements and financial principles. Has the 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.
4. 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. 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.
5. Standards of Performance: Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.
6. Physical Effort: Attendance is an essential function of the job. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
7. Hours: Based on business need. This is a hybrid position, and on-site attendance is a requirement.
8. Compensation: range is $110k - $150K MAX. plus variable incentive up to 15% of annualized eligible salary. Max rate listed is commensurate with 20+ years of experience offer is based on years of experience doing the duties of the role.