NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city’s five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Job Description

Working under the supervision of the Assistant Vice President of Managed Care, the key responsibilities of the Assistant Director position will focus on promoting system-wide awareness of managed care contractual terms and regulatory policies, with special focus on impacts to managed care and utilization management and value-based care management and coordination activities.

General tasks and responsibilities will include:

Managed Care and Utilization Management

A deep study and understanding of all NYC H+H managed care contracts and reimbursement policies and methodologies in order to identify and implement ways to appropriately maximize reimbursement and identify opportunities to optimize efficiencies for services rendered in inpatient care settings;  Working with Revenue Cycle to develop a routine cadence in working with the UM vendors to understand and escalate managed care related payment issues to contracted payers and monitoring those issues to resolution;  Establish and maintain efficient system-wide tools and methods to: 1) track and analyze revenue opportunities tied to inappropriate medical necessity denials, and 2) aid in implementing systemwide utilization management operations in conjunction with revenue cycle, quality and safety. Such workstreams may include: payer notification/preauthorization, concurrent review, extended stay documentation, discharge planning, and clinical appeal processes; Develop and maintain tools to track the changing federal and state regulatory landscape around utilization management and collaborate when requested in developing responses to proposed regulatory & policy changes that reflect NYC H+H position. Inventory health information exchange set ups with contracted managed care payers to identify any existing gaps impacting inpatient encounters and assist department in operationalizing Epic Payer Platform functionality. EPIC trained and able to investigate denials and underpayments. Collaborate with Post-Acute staff to facilitate communication between CO managed care to enhance knowledge of health plan provisions and negotiation activities.  Identify opportunities with Post- Acute staff to enhance work flows and contract provisions that will lead to increased revenue.   Other job-related duties as required. 

Minimum Qualifications

1. Master’s degree from an accredited college or university in Accounting, Finance, Business Administration or a related discipline with an emphasis on accounting and financial systems; and two (2) years of responsible-level experience in fiscal management or administration with an emphasis on financial systems, management information and controls, one (1) year of which must have been in a responsible administrative or managerial capacity; or
2. Bachelor’s degree from an accredited college or university in disciplines, as listed in “1” above; and three (3) years of experience, as described in “1” above, one (1) year of which must have been in a responsible administrative or managerial capacity.

Department Preferences

Masters Degree - four (4) years of experience in a corporation, consulting firm, governmental agency or foundation in management analysis or in operational direction, planning or coordination.   Baccalaureate Degree – six (6) years of similar experience as detailed above Managed Care background  Well organized and keenly attentive to detail 

NYC Health and Hospitals offers a competitive benefits package that includes:

Comprehensive Health Benefits for employees hired to work 20+ hrs. per week Retirement Savings and Pension Plans Loan Forgiveness Programs for eligible employees Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts College tuition discounts and professional development opportunities Multiple employee discounts programs