Director of Managed Care Contracting - Stony Brook Medicine : Job Details

Position Summary

Director of Managed Care Contracting – Stony Brook Medicine

Stony Brook Medicine is seeking an experienced and strategic Director of Managed Care Contracting to lead our Managed Care Contracting Team within the Department of Managed Care. This leadership role is responsible for the oversight, negotiation, and management of all Managed Care contracts for the health system, ensuring compliance with contractual obligations, State and Federal regulations, and alignment with organizational financial goals.

Responsibilities

• Lead and manage the daily operations of the Managed Care Contracting Team.
• Oversee and direct the negotiation, execution, and administration of all hospital, physician, and ancillary Managed Care contracts.
• Maintain accurate, up-to-date Managed Care contract databases and tracking tools.
• Timely review contract terms and upon renewal draft necessary language revisions to protect the organization's interests and mitigate risk.
• Ensure compliance with contractual obligations, including financial, operational, and facility credentialing requirements, within specified timeframes.
• Support internal operational departments by addressing contractual disputes, claim denials, and reimbursement issues.
• Participate in and support Joint Operating Committee (JOC) meetings, contract settlement discussions, and reimbursement escalations.
• Ensure compliance with Medicare and Medicaid reimbursement methodologies and stay current on commercial and government changes affecting the organization.
• Monitor and dispute Managed Care payer reimbursement policies or practices that breach contract terms, track resolution outcomes.
• Oversee facility credentialing process.
• Maintain comprehensive knowledge of applicable New York State regulations and federal regulations, and managed care industry standards.
• Develop and implement contracting team policies, procedures, and workflow improvements.
• Prepare and present reports to leadership on contract status, financial impacts, and strategic opportunities.

Qualifications

• Master's Degree (MS, MBA, MHA, MPH, or related).
• Minimum of five years of progressive managed care experience with a strong emphasis on hospital and physician contracting within a hospital, health system, physician group, or payer environment.
• Direct, hands-on experience negotiating and managing contracts for hospitals, health systems, physician groups, and ancillary services.
• Ability to independently lead complex payer contract negotiations, draft redline agreements, perform reimbursement analysis, and develop contracting strategies that align with organizational goals.
• At least three years of leadership or management experience.
• Strong knowledge of New York State, Federal, commercial payer reimbursement methodologies and Managed Care regulations.
• Proficiency in Microsoft Office applications (Excel, Word, PowerPoint) and experience managing contract management databases.
• Excellent organizational and analytical skills.
• Proven ability to communicate and resolve issues effectively through written and verbal communication.

• Experience leading Managed Care contracting for an integrated delivery system with multiple hospitals, physician groups, and ancillary service lines.
• Familiarity with alternative payment models, including bundled payments, shared savings arrangements, capitation and other risk-based agreements.
• Experience managing facility credentialing processes.
• Working knowledge of Revenue Cycle operations, including prior authorization, denial management, and payer policy interpretation as it relates to Managed Care contracts.
• Proficiency with contract management systems and analytics tools used for contract modeling and financial analysis.
• Proven track record of successful payer relations and dispute resolution.
• Demonstrated ability to develop strategic contracting initiatives that improve financial performance and access to care.
• Experience presenting to or collaborating with leadership on managed care performance strategy.

Special Notes

Resume/CV should be included with the online application.

Posting Overview

This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. For full consideration, applications must be received before the initial review date.

If no candidate is identified during the initial review, additional applications may be considered; however, the posting will close once a finalist is identified. If no candidate is hired within 90 days from initial posting, the posting may close for review and be reposted at a later date.

Equal Employment Opportunity

Stony Brook University is committed to diversity and an inclusive environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status, or other protected classes. If you need a disability-related accommodation, please contact the University Office of Equity and Access.