Director of Managed Care

Atlantic Health; Morristown (NJ); On-site; USD 180,000 - 240,000; Full time

Job summary

Atlantic Health seeks a Director of Managed Care to lead strategy, execution, and performance across FFS and value-based arrangements. You will oversee contract negotiations, payer relations, medical economics, and reimbursement modeling, aligning contracting with organizational goals.

The role reports to the Vice President of Insurance Networks and partners with Finance, Revenue Cycle, Population Health, and Clinical Operations to optimize hospital revenue and drive enterprise-wide financial

Qualifications

• Bachelor’s degree required.
• Master’s degree strongly preferred.
• Minimum six years of managerial experience in managed care, health insurance, or payer contracting.

Responsibilities

• Oversee system-wide managed care contracting across hospitals, physician enterprise, ambulatory centers and value-based arrangements.
• Develop and execute contracting strategies anticipating market shifts and regulatory changes.
• Lead creation of innovative contract structures to support financial, operational, and quality goals.
• Build and maintain strong payer relationships with transparency and accountability.
• Oversee credentialing, billing, reimbursement, and payer policy interpretation with internal stakeholders.
• Direct analytics, modeling, and performance monitoring for FFS and VBC.
• Ensure accurate pricing of claims through contract configuration and Revenue Cycle collaboration.
• Lead value-based programs including shared savings, bundled payments, downside risk, and capitation.
• Monitor payer performance and reimbursement outcomes to identify improvements and mitigate risk.
• Guide bundled payment strategies and participate in system-wide risk-based program development.

Skills

Leadership

Contract negotiation

Payer relations

Financial analysis

Executive communication

Education

Bachelor’s degree in Healthcare Administration, Business, Public Health, STEM, or related field

Master’s degree in Health or Business Administration

Tools

Epic

Job description

The Director of Managed Care serves as the leader responsible for the strategy, execution, and performance of all managed care activities across both fee-for-service (FFS) and value-based care (VBC) arrangements. Reporting to the Vice President of Insurance Networks, this role oversees the teams responsible for contract negotiations, payer relations, medical economics, reimbursement modeling, and value-based program performance. The Director leads the development, negotiation, implementation, and monitoring of all hospital, physician, ambulatory, and ancillary managed care agreements. This includes ensuring accurate contract configuration, optimizing reimbursement, and driving payer accountability. The role also provides executive oversight of the organization’s value-based payment portfolio- including shared savings, downside risk, bundled payments, and capitation- ensuring the system achieves quality, cost, and financial targets. This leader collaborates closely with Finance, Revenue Cycle, Population Health, Clinical Operations, and site CFOs to align contracting strategy with organizational goals, support growth initiatives, and develop the annual hospital revenue budget. The Director is a key architect of the system’s managed care strategy and a central driver of enterprise-wide financial performance.

Key Responsibilitie

sSystem-Wide Managed Care Leadershi

• pProvide oversight for all managed care contracting across the system, including hospitals, physician enterprise, ambulatory centers, ancillaries, and value-based arrangements
• .Develop and execute contracting strategies that anticipate market shifts, payer policy changes, and regulatory developments
• .Lead the creation of innovative contract structures that support system-wide financial, operational, and quality goals
• .Build and maintain strong payer relationships, ensuring transparency, accountability, and alignment with organizational priorities
• .Oversee credentialing, billing, reimbursement, and payer policy interpretation in collaboration with internal stakeholders
• eDirect the teams responsible for FFS and VBC analytics, modeling, and performance monitoring
• .Ensure accurate pricing of claims through Epic contract configuration and partner with Revenue Cycle to optimize contractual performance metrics
• .Lead the development, valuation, and tracking of all value-based programs, including shared savings, bundled payments, downside risk, and capitation
• .Monitor payer performance, utilization trends, and reimbursement outcomes to identify opportunities for improvement and risk mitigation
• .Guide the organization’s strategy for bundled payment programs and participate in system-wide risk-based program development

.Medical Economics & Financial Strateg

• yProvide strategic oversight of medical economics functions, ensuring accurate modeling, forecasting, and financial impact analyses
• .Direct analytical resources to evaluate alternative contract proposals, quantify financial implications, and support negotiation strategy
• .Review and approve analyses related to payer policy changes, regulatory updates, and reimbursement shifts
• .Oversee the maintenance of detailed utilization and payment databases, ensuring accurate benchmarking and performance tracking
• .Monitor cash realization relative to contract value and develop strategies to address denials, underpayments, and payment deprivation

.Network Managemen

• tOversee network adequacy and access standards for the system’s self-insured employee health plan
• .Negotiate reimbursement terms with community providers to support Tier 1 network growth and cost containment
• .Develop standing rate agreements that enable bundled and episodic risk programs
• onLead, mentor, and develop teams across contracting, payer relations, and medical economic
• s.Foster a culture of collaboration, transparency, and innovatio
• n.Communicate complex concepts clearly to executives, physicians, and cross-functional partner
• s.Represent Managed Care in system-wide initiatives, interdisciplinary workgroups, and strategic planning effort

s.Qualificatio

nsEducati

• onBachelor’s degree in Healthcare Administration, Business, Public Health, STEM, or related field require
• d.Master’s degree in Health or Business Administration strongly preferre

d.Experience & Requiremen

• tsMinimum of six years of managerial experience in managed care, health insurance, or payer contracting, with exposure to both hospital and physician environment
• s.Extensive experience in contract negotiation, payer relations, and managed care complianc
• e.Proven ability to manage networks of hospital, physician, and ambulatory provider
• s.Strong understanding of patient accounting, billing, collections, and reimbursement analysi