Director of Managed Care Strategy & Payer Leadership

Atlantic Health; Morristown (NJ); Vor Ort; USD 200.000 - 320.000; Vollzeit

Zusammenfassung

Atlantic Health in Morristown, NJ seeks a Director of Managed Care to lead strategy, execution, and performance of all managed care activities across FFS and VBC. You will oversee contract negotiations, payer relations, medical economics, and reimbursement modeling, aligning with the organization’s goals and revenue budget.

The role requires at least six years of managerial experience in managed care, strong negotiation and analytics skills, and a track record of improving financial and quality

Qualifikationen

• Six years minimum of managerial experience in managed care, health insurance, or payer contracting.
• Experience in contract negotiation, payer relations, and managed care compliance.
• Proven ability to manage networks of hospital, physician, and ambulatory providers.
• Strong understanding of patient accounting, billing, and reimbursement analysis.

Aufgaben

• Provide 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.
• Direct 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.
• Provide 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.
• Oversee 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.
• Lead, mentor, and develop teams across contracting, payer relations, and medical economics.
• Foster a culture of collaboration, transparency, and innovation.
• Communicate complex concepts clearly to executives, physicians, and cross‑functional partners.

Kenntnisse

Contract negotiation

Payer relations

Managed care leadership

Financial modeling

Ausbildung

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

Master’s degree in Health or Business Administration

Tools

Epic

Jobbeschreibung

Atlantic Health in Morristown, NJ seeks a Director of Managed Care to lead strategy, execution, and performance of all managed care activities across FFS and VBC. You will oversee contract negotiations, payer relations, medical economics, and reimbursement modeling, aligning with the organization’s goals and revenue budget.

The role requires at least six years of managerial experience in managed care, strong negotiation and analytics skills, and a track record of improving financial and quality