NorthBay Health · 21 hours ago
Vice President, Managed Care and Health Plan Integration
Fairfield, CA
Full-time
Onsite
Director/Executive
$300K/yr - $375K/yr
10+ years expNorthBay Health is a rapidly expanding, physician-guided, integrated health system. The Vice President, Managed Care and Health Plan Integration is responsible for accelerating the profitable growth of the health plan, deepening payer relationships, and integrating the health system into the communities served.
HealthcareHospitalHealth CareMedical
Responsibilities
Health Plan Growth & Profitability
Lead/support membership growth strategy targeting commercial, Medicare MediCal/Partnership lines of business (goal: align with ANS growth strategy targets)
Oversee product design, pricing, network strategy, and benefit configuration in collaboration with actuarial, clinical, and sales teams
Achieve and exceed annual medical loss ratio (MLR), administrative expense, and margin targets
Managed Care Contracting & Payer Strategy
Negotiate and manage all external payer contracts (national, regional, and local plans) to maximize system reimbursement while protecting health plan competitiveness
Serve as the enterprise expert on value-based contracting, bundled payments, and risk arrangements
Community Awareness, Brand Integration & Market Expansion
Develop and execute a comprehensive community engagement and brand-integration strategy in conjunction with the Marketing Communication Team so that the health system and health plan are recognized as the preferred, local choice in every new and existing market
Build strategic partnerships with large employers, chambers of commerce, school systems, FQHCs, faith-based organizations, and municipal governments
Lead employer direct-to-employer (DTE) sales and narrow-network product launches
Clinical & Financial Integration
Partner with Population Health, clinical leadership, and medical group presidents to hardwire clinical programs (chronic disease management, transitional care, behavioral health integration) that simultaneously improve health plan STAR/HEDIS performance and reduce system total cost of care
Drive shared savings and risk-revenue performance across Medicare ACOs, MSSP, and commercial risk contracts
Leadership & Team Development
Build and lead a lean, high-performing team (contracting, network development, provider relations, community engagement, health plan sales/support)
Serve as a key member of the system leadership team and prepare regular updates for the system board of directors
Qualification
Required
Bachelor's degree required
Ten to fifteen (10–15+) years progressive managed care leadership experience within a health system, health plan, or large medical group
Proven track record of growing a health insurance plan or major product line (membership and profitability)
Deep expertise in value-based care contracting, payer negotiations, and risk arrangement design
Demonstrated success in employer sales, community partnership development, and brand-building in competitive markets
Experience with Medicare Advantage, Medicaid managed care, and commercial products
Exceptional communication skills with experience presenting to boards, large employers, and community stakeholders
Demonstrates the True North values: Nurture/Care, Own It, Respect Relationships, Build Trust and Hardwire Excellence
Willingness to travel 30–40% across current and expansion markets
Preferred
Master's (MHA, MBA, MPH) strongly preferred
Current or prior P&L responsibility for a health plan or major business unit preferred
Experience launching narrow-network or direct-to-employer products preferred
Existing relationships with national and regional payers in our footprint preferred
Company
NorthBay Health
NorthBay Health is a locally based, nonprofit health care organization serving Solano County since 1960.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Mark Behl, MHA, MBA
President and CEO
Christopher Timbers
Vice President, CIO
Recent News
GlobeNewswire News Room
2025-01-30
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