Nursing Associate Director: Managed Care & Contracts

NYC Health and Hospitals; New York (NY); On-site; USD 151,000 - 160,000; Full time

Benefits offered by this job

Comprehensive Health Benefits for 20+H

Retirement Savings and Pension Plans

Paid Holidays and Vacation

Loan Forgiveness Programs

College tuition discounts

College Savings Program

Union Benefits

Employee discounts

Commuter Benefits

Job summary

NYC Health + Hospitals is seeking an Associate Director of Nursing to oversee managed care contracts and ensure effective care coordination with MCOs, while safeguarding financial performance. The role is based in New York, NY, within the CASE MANAGEMENT unit and executes a full-time daytime schedule.

Required are a Master’s in Nursing Administration (or related field) with NY RN licensure, 3 years nursing, and 2 years in admin or supervisory roles; BLS may be required.

Qualifications

• Master's Degree in Nursing Administration or related nursing discipline required.
• Bachelor's Degree in Nursing also acceptable.
• Three (3) years of nursing experience, two (2) years in a responsible administrative or supervisory capacity required.
• Valid New York State license and current registration to practice as a Registered Professional Nurse in New York State.
• Basic Life Support (BLS) may be required depending on assignment.

Responsibilities

• Support escalations to Central Corporate Managed Care regarding issues with MCOs.
• Facilitate seamless care coordination between facilities, MCOs, and other healthcare providers.
• Prepare for contract negotiations with MCOs in collaboration with the Central Office Managed Care Team.
• Monitor and evaluate facility performance against contractual obligations.
• Conduct and summarize concurrent and retrospective reviews of resident/patient care authorizations.
• Analyze and report on denial trends, identifying key issues and effectiveness of the appeals process.
• Implement quality improvement initiatives based on performance data and feedback from MCOs.
• Prepare comprehensive analyses of MCO payments, identifying trends and areas for improvement.
• Monitor contract performance, including payment accuracy and compliance with contract terms.
• Ensure all managed care contracts comply with state and federal regulations.

Skills

Care coordination

Contract management

Data analysis

Quality improvement

Healthcare administration

Education

Master's in Nursing Administration

Bachelor's in Nursing

Job description

NYC Health + Hospitals is seeking an Associate Director of Nursing to oversee managed care contracts and ensure effective care coordination with MCOs, while safeguarding financial performance. The role is based in New York, NY, within the CASE MANAGEMENT unit and executes a full-time daytime schedule.

Required are a Master’s in Nursing Administration (or related field) with NY RN licensure, 3 years nursing, and 2 years in admin or supervisory roles; BLS may be required.