Manager, Managed Care Contracting & Operations

Northbay Healthcare

Fairfield, CA

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JOB DETAILS

SALARY

$130,000–$150,000 Per Year

JOB TYPE

Full-time

SKILLS

Acute Care, Analysis Skills, Cancer, Cardiovascular, Claims Management, Claims Processing, Compensation and Benefits, Contract Management, Contract Negotiation, Data Analysis, Data Collection, Data Management, Detail Oriented, Distribution Channel, Frequently Asked Questions (FAQ), Health Insurance, Healthcare, Healthcare Reimbursement, Hospice Care, Hospital, Insurance, Managed Care, Market Share, Mathematics, Negotiation Skills, Neonatal Intensive Care Unit (NICU), Neuroscience, Nonprofit, Operations Management, Organizational Development/Management, Organizational Skills, Orthopedics, Patient Care, Pricing, Primary Care, Problem Solving Skills, Quantitative Analysis, Reconciliation, Reimbursement, Staff Training, Surgical Procedures, Team Player, Time Management, Urgent Care, Work From Home

LOCATION

Fairfield, CA

POSTED

30+ days ago

At NorthBay Health The Manager, Managed Care Services possesses both operational management and negotiating skills. The leader is responsible for payor strategy, contracting, reimbursement and 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. This person 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. At NorthBay Health, our vision is to be the trusted healthcare partner of choice for the communities we serve. We are dedicated to improving the well-being of our community by providing accessible, high-quality care to all who need it. Every member of our team plays a vital role in delivering compassionate and effective healthcare solutions. We invite you to join us in our mission to ensure that every patient and family member feels valued, respected, and cared for throughout their healthcare journey.Primary Job ResponsibilitiesCommunicate the changing landscape of payor network, pricing, consolidation and payment strategies. Suggest strategies for mitigating financial damage to NorthBay in advance of the implementation of these strategies by payors.Conduct Payor Contract Negotiations under oversight of leadershipConduct or oversee Subcontract Negotiations.Manage or Oversee Operationalization and staff education of managed care contracts and related topics.Manage or Oversee Data Collection and Analysis.Oversee the management of the claim’s payment function for hospital and medical group claims.Manage or Oversee capitation reconciliation and stop loss functions.Education. Bachelor’s degree required.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 \'bonus\' Max rate listed is commensurate of 20+ years of experience offer is based on years of experience doing the duties of the role.About UsInterpersonal Skills and ValuesDemonstrates NorthBay Health’s True North Values: Nurture Care, Own It, Respect Relationships, Build Trust, and Hardwire Excellence. These values guide behavior, accountability, teamwork, and commitment to high-quality patient care.Why NorthBay HealthNorthBay Health is an independent, nonprofit health system serving the Napa, Solano, and Yolo County regions. We are expanding access to care across our communities through two acute-care hospitals, including a Level II Trauma Center and a Level III NICU maternity unit, along with a cancer center, urgent care locations, and a growing network of primary and specialty care clinics.We provide advanced services in cardiovascular care, neuroscience, orthopedics, surgery, and outpatient specialties. NorthBay Health is nationally recognized for quality care, including Magnet with Distinction designation for nursing and multiple U.S. News and World Report high performing recognitions.We are committed to being the trusted healthcare partner of choice and offer an environment where employees can grow, contribute meaningfully, and support the health of our communities.NorthBay Health Benefits OptionsNorthBay Health offers a comprehensive benefits package based on established eligibility requirements. Benefits may include medical, dental, and vision insurance, life, disability, and long-term care coverage, paid time off including vacation, sick leave, holidays, and bereavement, a 403(b) retirement plan with employer match, education reimbursement for eligible roles, professional development and training programs, Employee Assistance Program, wellness programs, recognition programs, shift differentials, and market-based compensation review and increases subject to approval and organizational performance.Compensation StructureNorthBay Health uses a structured compensation framework. Staff-level positions use a step-based system (Steps 1–5) based on years of directly related experience, with Step 5 representing 20 or more years of experience in the role. Manager level and above positions are paid a fixed annual base salary and are eligible for a variable incentive compensation plan. Physician compensation is structured based on specialty and role requirements.Remote Work DisclosureNorthBay Health is primarily an onsite organization due to the nature of healthcare. Some roles may allow hybrid or remote work based on business needs.Remote work is not supported in Washington, Ohio, Wyoming, North Dakota, Puerto Rico, the U.S. Virgin Islands, or outside of the United States.Notice to Recruitment AgenciesNorthBay Health utilizes a managed service provider (MSP) for agency partnerships and is not currently engaging external recruiting firms outside of established agreements. We do not accept unsolicited resumes or third-party candidate submissions. Please do not contact NorthBay Health employees, leaders, physicians, or hiring managers regarding recruitment or job postings.More InformationVisit NorthBay Health Careers for recruitment FAQs and additional information.

About the Company

Northbay Healthcare

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