Executive Director - Managed Care Operations
Company: Northeast Georgia Medical Center
Location: Gainesville
Posted on: April 2, 2026
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Job Description:
Job Category: Administrative & Clerical, Executive Leadership
Work Shift/Schedule: 8 Hr Evening - Morning Northeast Georgia
Health System is rooted in a foundation of improving the health of
our communities. About the Role: Job Summary The Director of
Managed Care conducts and coordinates the functions involved in
Managed Care operations and contracting activities at the System
level. Monitors and updates the administrative staff on political,
legal and regulatory trends with respect to managed care and
vertical integration. Works with Medical Economics, Finance and
Revenue Cycle to produce reports for the Executive Director
concerning managed care contract modeling and contract performance.
This position is responsible for managed care financial analysis
and analyzing contract proposals. This position is responsible for
the medical economics staff and operation. This position will work
with the various Revenue Cycle components/departments to ensure
negotiation of the most appropriate contract terms/structures, etc.
This position will work as a liaison between with managed care
payers and system to facilitate resolution of contractual and
operational issues in order to enhance managed care contract
performance. Minimum Job Qualifications Licensure or other
certifications: Educational Requirements: Bachelors Degree. Minimum
Experience: Seven (7) years of managed care contracting and/or
managed care finance experience. Other: Preferred Job
Qualifications Preferred Licensure or other certifications:
Preferred Educational Requirements: Preferred Experience: Other:
Job Specific and Unique Knowledge, Skills and Abilities Possess
extensive knowledge of the Managed Care environment in Georgia or
similar market Possess successful relationship building skills Self
motivated with strong organizational and planning skills Good
written communication skills including email Excellent analytical
skills through use of various spreadsheet software (i.e. Excel),
querying software and/or contract management programs Essential
Tasks and Responsibilities Responsible for research, analysis and
negotiation of contractual agreements. Attend meetings with
representatives of Managed Care Organizations, gathering
information on their market presence and future development.
Coordinate the review of managed care contract language to achieve
optimal reimbursement for NGHS and to promote internal efficiencies
among internal departments that are affected by said contracts.
Perform service specific reviews of volume and pricing in an effort
to maximize contract performance. Coordinate, prepare for and
attend regular negotiation meetings with contracting parties.
Coordinate the administration/management of contracts through NGHS
system, ensuring the dissemination of appropriate contract
information to necessary internal/external users. Responsible for
producing accurate final original documents. Development of the
Medicare Advantage strategic goals and objectives, including the
community focus and contracting strategic plan. Support VP of
Managed Care in new contracting initiatives such as pay for
performance. Establish relationships and serve as operational
contact point with all contracting parties. Maintain lines of
communication with payer contracting staff throughout contract
item. Coordinate meetings with payers where the need is related to
joint operations. Work with VP and Senior Management to lead the
departmental efforts for effective employer engagement in an effort
to prepare NGHS for a future with potential employer direct
contracting. Oversee the additional of new facilities, new
physicians and new services to managed care contracts. Serve as a
liaison between various NGHS departments and Managed Care
Operations. Oversee response to calls and emails from NGHS
departments. Improve overall Managed Care integration into the NGHS
organization through communication. Coordinate communication and
education of physicians to ensure most accurate administration of
contracts and efficient NGHS operations. Coordinate communication
and education of staff to ensure most accurate administration of
contracts and efficient NGHS operations. Oversee the development
and monitoring of managed care contracts. Develop and evaluate
reports regarding the managed care contract performance and payment
variances. Oversee managed care payment variance review function.
Manage and maintain annual schedule of terminations, renewals,
escalators, etc. Analyze payment variance reports/trends.
Coordinate activities related to contract rate development,
modeling prediction, and other analyses as required to support NGHS
Finance and Revenue Cycle. Manage and coordinate Medical Economics
department. Act as the point of contact for Finance and Revenue
Cycle concerning procedure pricing (CDM), contract rates and
managed care contract performance. Coordinate with report building
for various departmental needs. Coordinate with payer research
relative to new technologies contemplated by NGHS. Coordinate
information gathering and feedback with industry experts on managed
care market environment and NGHS relative market position. ?
Physical Demands Weight Lifted: Up to 20 lbs, Frequently 31-65% of
time Weight Carried: Up to 20 lbs, Frequently 31-65% of time
Vision: Moderate, Frequently 31-65% of time
Kneeling/Stooping/Bending: Occasionally 0-30% Standing/Walking:
Occasionally 0-30% Pushing/Pulling: Occasionally 0-30% Intensity of
Work: Occasionally 0-30% Job Requires: Reading, Writing, Reasoning,
Talking, Keyboarding Working at NGHS means being part of something
special: a team invested in you as a person, an employee, and in
helping you reach your goals. NGHS: Opportunities start here.
Northeast Georgia Health System is an Equal Opportunity Employer
and will not tolerate discrimination in employment on the basis of
race, color, age, sex, sexual orientation, gender identity or
expression, religion, disability, ethnicity, national origin,
marital status, protected veteran status, genetic information, or
any other legally protected classification or status.
Keywords: Northeast Georgia Medical Center, North Atlanta , Executive Director - Managed Care Operations, Administration, Clerical , Gainesville, Georgia
