Regional Manager, Managed Care Contracting in Denville, NJ at Prime Healthcare

Date Posted: 10/29/2020

Job Snapshot

  • Employee Type:
  • Location:
    66 Ford Road
    Denville, NJ
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Responsibilities Regional Manager, Managed Care - Health Plan Operations is responsible for the management and data integrity of the managed care agreements in place at all hospital facilities. The Regional Manager effectively interacts with Corporate Executive Management, Hospitals and Business Office Management and commercial insurance payers. The Regional Manager will work on contract negotiations (language and rates); manage ongoing payer relationships; monitor regulatory, provider manual, and related process changes; assist in the measurement of payer compliance with contract terms; participate in JOCs; and assist hospital and business office management in resolution of issues related to managed care agreements.



1. Bachelor of Business/health/management field or relevant bachelor’s degree
2. Analytical skills with emphasis on contract development, assessment and negotiation, financial analysis problem solving and project/time management
3. 5 years of contract negotiation/managed care experience in a hospital or hospital system setting, required
4. Business office and claims knowledge and/or experience, preferred
5. Must obtain Sexual Harassment Certification within 6 months, and then maintain biennially.

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: