Manager, Managed Care Contracting & Operations at Northbay

Fairfield, California, United States -

Full Time

Start Date

Immediate

Expiry Date

12 Aug, 26

Salary

150000.0

Posted On

14 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Payor Strategy, Contract Negotiation, Healthcare Reimbursement, Claims Processing, Managed Care Operations, Data Collection And Analysis, Capitation Reconciliation, Stop Loss Functions, Strategic Thinking, Quantitative Analysis, Mathematical Skills, Verbal Communication, Writing Skills, Problem Solving, Detail Orientation, Financial Principles

Industry

Hospitals and Health Care

Description

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 RESPONSIBILITIES * Communicate 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 leadership * Conduct 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. Interpersonal Skills and Values Demonstrates 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 Health NorthBay 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 Options NorthBay 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 Structure NorthBay 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 Disclosure NorthBay 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 Agencies NorthBay 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 Information Visit NorthBay Health Careers for recruitment FAQs [https://www.northbay.org/careers/recruitment-faq.html] and additional information.

Responsibilities

Responsible for payor strategy, contract negotiations, and the operational management of claims processing and reimbursement. Oversees the implementation and monitoring of managed care contractual arrangements for hospitals, physicians, and ancillary services.