Assistant Director of Ambulatory Care Services (Referrals & Community Provider Program)

Since 1875, South Brooklyn Health has established its reputation for clinical excellence and culturally competent care. It has designations as a Certified Percutaneous Coronary Intervention (PCI) Center, an Advanced Primary Stroke Center, an accredited Baby-Friendly Hospital, a U.S. News & World Report high performing hospital. The hospital's staff is as diverse as the patients they serve. Interpreter services can be provided at any time of the day or night in over 130 languages.

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.

Work Shifts

9:00 A.M - 5:00 P.M

Job Description

Purpose:

The Director of Managed Care will be responsible for strengthening relationships with community providers, ensuring timely and cost-effective access to specialty, secondary, and tertiary care, including diagnostics, lab services, procedures, and surgeries. This leadership position will oversee a variety of managed care initiatives, from network management to patient access and referral processes, while ensuring high-quality patient care and cost management.

Specific Duties and Responsibilities:

The Assistant Director of Ambulatory Care Services is charged with and responsible for:

• Leadership & Strategic Oversight: Lead and manage the day-to-day operations of the Managed Care Department, providing strategic direction, oversight, and guidance to a team of care coordinators, analysts, and other staff members.
• Community Provider Network Growth: Drive the expansion of the community provider network by actively engaging with local healthcare providers to increase their referrals to our organization for specialty, secondary, and tertiary care services, including diagnostics, lab services, procedures, and surgeries.
• Network Development & Management: Oversee the development and maintenance of a robust provider network, working closely with community physicians, specialists, and healthcare facilities to ensure high-quality care and seamless patient referrals.
• Referral Management & Access to Care: Oversee the organization-wide referral management process, ensuring that referrals from community providers are processed efficiently. Ensure that patients have timely access to the appropriate specialty care and that all necessary documentation and registration criteria are met ahead of scheduled visits.
• Utilization Management: Implement and monitor programs for effective utilization review, ensuring that healthcare services are medically necessary, cost-effective, and appropriate for the patient's condition.
• Claims Management & Cost Control: Oversee the processing and management of insurance claims, ensuring timely approvals, accurate claims adjudication, and resolution of claims disputes.
• Data Analysis & Reporting: Utilize data analytics to assess and improve the effectiveness of managed care programs, ensuring cost control measures are met while maintaining or improving patient care outcomes.
• Quality Improvement Initiatives: Develop and implement quality assurance programs to measure and improve the quality of care provided to patients in managed care programs.
• Compliance & Regulatory Adherence: Ensure all managed care programs comply with federal, state, and local regulations, as well as industry best practices and company policies.
• Collaboration & Communication: Build strong relationships with internal teams, external providers, and insurance carriers to ensure smooth coordination of care and continuous improvement in service delivery. Foster open communication with community providers to increase their engagement and referrals.
• Front-End Process Optimization: Ensure the front-end processes for patient registration, including insurance verification, eligibility checks, and referral processing, are streamlined to meet registration criteria and support seamless access to care.
• Budget & Financial Management: Manage departmental budget and financial planning, including setting targets for cost reduction while maintaining quality care standards.
• Education & Training: Provide training and support to team members and healthcare providers on managed care practices, insurance plan details, and relevant policies or procedures

Minimum Qualifications
1. A bachelor's degree from an accredited college or university in Business Administration, Social Sciences, Management, Health Care Administration or related discipline; and,
2. Six (6) years of full-time paid experience of program development in a hospital or health care facility in meeting community health needs, health care planning, financial planning, operations and analysis and implementation in an administrative, consultative, managerial or executive capacity; or,
3. A master's degree from an accredited college or university and five (5) years of full-time paid experience at the level indicated in (2) above.
4. Demonstrated skills in written and medical communications; or,
5. A satisfactory equivalent of education, training and experience.

Department Preferences

• Proven success in expanding and managing community provider networks, with experience engaging providers to increase specialty referrals and care coordination.
• Strong knowledge of healthcare management, insurance plans, reimbursement models, and regulatory requirements.
• Excellent negotiation, communication, and interpersonal skills, with the ability to build relationships with community providers and stakeholders.
• Ability to analyze complex data and provide actionable insights.
• Proven ability to manage cross-functional teams and drive organizational change.
• In-depth understanding of utilization management, cost containment, quality improvement practices, and front-end processes related to patient referrals and registration.
• Certification in managed care or related field (e.g., Certified Managed Care Professional (CMCP)) is preferred.

If you wish to apply for this position, please apply online by clicking the "Apply for Job" button.

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