Manager, Managed Care Services (Hybrid/On-Site)

NorthBay Healthcare Group; Fairfield (CA); Hybrid; USD 130,000 - 150,000; Full time

Job summary

NorthBay Healthcare Group in Fairfield, CA seeks a Manager of Managed Care Services to lead contract negotiations and oversee claims processing and payor arrangements. This is a hybrid role with on-site duties three days per week.

The ideal candidate has strong negotiation skills, healthcare reimbursement experience, and the ability to balance strategic and practical execution. Excellent written and verbal communication are required.

Qualifications

• Education: Bachelor's degree or 8+ years in managed care leadership.
• Experience: Minimum 3 years in healthcare reimbursement and contract negotiations.
• Skills: Thinks strategically and tactically; strong written and verbal skills; analytical skills.
• Interpersonal: Demonstrates NorthBay True North values and leadership initiative.
• Hours: Based on business needs.
• Compensation: $130K-$150K plus up to 15% incentive; 20+ years experience cap may apply.

Responsibilities

• Negotiate with health insurance companies on contract terms for hospital, physician and ancillary services.
• Oversee implementation, monitoring and evaluation of payor contractual arrangements to protect market share.
• Oversee subcontract negotiations for capitated business and hospice program.
• Educate staff on managed care topics and contract implementation.

Skills

Negotiation

Healthcare reimbursement

Contract management

Leadership

Analytical skills

Education

Bachelor's degree or 8+ years managed care leadership

Job description

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

At Northbay Health t he Manager of Managed Care Services possesses both operational management and negotiating skills. She or he is responsible for communicating potential threats to Northbay resulting from changes in the insurance industry, while also being responsible for contract negotiations and the operations associated with claims processing.

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 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.

• - Education. Bachelors' degree required or minimum 8 years of experience in managed care services demonstrating leadership qualities.
• - Experience: Minimum 3 years of experience required in, healthcare reimbursement mechanisms and contract negotiations. Prior experience in a managed care organization or department required.
• - 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.
• - 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.
• - Hours : Based on business need.
• - Compensation: $130K - $150K plus variable incentive up to 15% of annualized eligible salary. Max rate listed is commensurate of 20+ years of experience offer is based on years of experience doing the duties of the role.