Managed Care Director

LE001 Richmond Medical Center; New York (NY); On-site; USD 170,000 - 180,000; Full time

Job summary

Richmond University Medical Center in New York seeks a senior Contract Management Leader to oversee full lifecycle contracts for a managed care portfolio. You will drive financial oversight, compliance, and cross-department collaboration to optimize payer relationships and patient care.

The role demands strong negotiation, leadership, and analytical skills, with experience in hospital/health system contracting and healthcare software. Day shift on-site position.

Qualifications

• Bachelors in healthcare administration, business, or related field; Master’s preferred.
• 5+ years contracting experience in hospital/health system settings.
• 3+ years with medical insurance entities (MSO/IPA/TPA) preferred.
• Strong knowledge of managed care, regulations, and reimbursement.
• Excellent negotiation, communication, and interpersonal skills.
• Ability to analyze financial data and develop strategic plans.
• Proven leadership in building and managing teams.
• Proficiency in healthcare management software and MS Office.

Responsibilities

• Contract Management: oversee full life-cycle of managed care contracts.
• Strategize, negotiate, and implement contract terms and monitor performance.
• Ensure compliance with contract terms, financial guidelines, and parameters.
• Oversee billing, coding practices, and financial performance tracking.
• Lead department staff; hire, train, evaluate performance.
• Develop policies to streamline managed care operations across departments.
• Coordinate with clinical and admin teams to align patient care and contracts.
• Represent hospital in meetings with payers and regulatory bodies.

Skills

Negotiation

Communication

Interpersonal

Leadership

Financial analysis

Strategic planning

Healthcare software

Microsoft Office

Education

Bachelor’s in healthcare administration

Master’s degree preferred

Tools

Microsoft Office Suite

Healthcare management software

Job description

It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion and customer focus to the business. Day Shift - 7.5 Hours (United States of America)

Key Responsibilities:

1. Contract Management:
   • Perform full life-cycle Contract Management for a portfolio of managed care contracts
   • Develop administrative and technical contracting strategies through development, negotiation, implementation of terms, and monitoring contractual agreements on behalf of the Richmond University Medical Center and Richmond Health Network
   • Review, interpret, analyze, manage, negotiate complex agreements, resolve contractual issues, and ensure adherence to all contract language, financial guidelines, and parameters
   • Ensure compliance with contract terms and conditions.
   • Monitor and analyze contract performance, addressing any issues or discrepancies.
   • Develop and maintain processes to provide timely notification of critical contract events (e.g., renewals, termination and due dates contained within the agreements)
2. Financial Oversight:
   • Develop and implement strategies to maximize reimbursement and minimize denials.
   • Monitor financial performance, including budgeting, forecasting, and variance analysis.
   • Collaborate with the finance department to ensure accurate billing and coding practices.
   • Track and maintain financial performance and status for all contracts to monitor and coordinate financial analysis of payer contract performance and modeling projections
3. Operational Leadership:
   • Provide direction and supervision to assigned department staff in areas of contracting, contract management and provider relations
   • Assist in producing and disseminating contract information to all relevant departments, identify and resolve problems with contracts regarding billing, claims payment, scheduling, registration, credentialing, service development, care management, and noncompliance.
   • Lead and manage the managed care department, including hiring, training, and performance evaluation of staff.
   • Develop and implement policies and procedures to streamline managed care operations.
   • Coordinate with clinical and administrative departments to ensure seamless patient care delivery.
   • Support the entire contract process and closely collaborates with internal departments to ensure staff are informed of new contracts, changes to existing contracts and updates to the medical and billing policies of the payers.
4. Quality and Compliance:
   • Ensure compliance with all relevant regulations, standards, and guidelines (e.g., CMS, state regulations).
   • Implement quality improvement initiatives to enhance patient care and operational efficiency.
5. Relationship Management:
   • Serve as the primary liaison between the hospital and MCOs, insurance companies, and other payers.
   • Foster positive relationships to enhance collaboration and problem-solving.
   • Represent the hospital in managed care meetings and negotiations
   • Act as a liaison with Patient Financial Services, physician offices and health plans to resolve contractual issues and ensure compliance with negotiated contractual terms
6. Strategic Planning:
   • Develop and execute strategic plans to improve managed care operations and support the hospital’s overall goals.
   • Stay abreast of industry trends and best practices, implementing changes as needed.
   • Participate in strategic planning and decision-making processes at the executive level.

Qualifications:

• · Bachelor’s degree in healthcare administration, Business Administration, or a related field (Master’s degree preferred).
• · 5+ years’ contracting experience with hospital, clinic, physician, and or health system require.
• · 3+ years’ experience with medical insurance company, MSO, IPA, TPA, preferred.
• · Strong knowledge of managed care principles, healthcare regulations, and reimbursement methodologies.
• · Excellent negotiation, communication, and interpersonal skills.
• · Proven ability to analyze financial data and develop strategic plans.
• · Leadership skills with a track record of building and managing effective teams.
• · Proficiency in healthcare management software and Microsoft Office Suite.

Salary Range:

$170,000 - $180,000

Employment Non-Discrimination:

Richmond University Medical Center is committed to equality of opportunity in all aspects of employment and provides full and equal employment opportunities to all employees and potential employees without regard to race, color, national origin, religion, gender identity, sex, sexual orientation, pregnancy, childbirth and related medical conditions and needs including lactation accommodations, physical or mental disability, age, immigration or citizenship status, veteran or active military status, genetic information, or any other legally protected status.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us! Our Mission We the staff of Human Resources are proud to share a long-standing tradition of excellence at Richmond University Medical Center. We uphold the mission by providing premier quality patient care through a full spectrum of emergent, acute, primary, behavioral health and educational services, and value the pride and integrity that motivate us to always be more, and always be better. We are committed to our mission and values because WE CARE! We are Welcoming, Energized, Compassionate, Advocates, Respectful and Excellent in our interaction with our patients, families, visitors and co-workers.

WE CARE W We are welcoming and gracious toward each other, and toward all who come to receive our services.

E Personnel are energized for quality, creativity, commitment and teamwork.

C Compassion is the way we share deep concern and care toward each person.

A Advocacy is our activity that promotes the rights and responsibilities of patients, families, and staff, in the hospital setting and in the community.

R We show respect by recognizing the basic dignity of every person in all our interactions and in the formulation of policies and procedures.

E Excellence is our way of demonstrating that we can always be more and always be better.