Manager, Managed Care Contracting & Operations

At North Bay 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 North Bay 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 North Bay 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 North Bay 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 North Bay 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.

Education.

Experience:

• Minimum 3 years of experience required in, healthcare reimbursement mechanisms and contract negotiations.
• Prior experience in a managed care organization or department required.

• 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.

• 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 North Bay 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.

• Based on business need.

• $130k - $140k
• Max rate listed is commensurate of 20+ years of experience offer is based on years of experience doing the duties of the role.

At North Bay Health, we are guided by our values:
Nurturing Care;
Own It;
Respect;
Build Trust; and Hardwire Excellence. These principles lead us to our TRUE NORTH and inspire us to provide exceptional care.

These values serve as the foundation of everything we do, guiding us to deliver individualized care with integrity…