Regional Vice President, Managed Care Contracting
About The Position
Prime Healthcare is seeking a Regional Vice President, Managed Care Contracting to develop and implement managed care strategies for the organization. The role develops alignment models, including pay for performance, bundled payments, and various forms of risk contracting, and negotiates and administers contracts with managed care payers. It is responsible for planning, evaluating, and implementing managed care programs through contract negotiations with managed care entities. The position also assesses and structures reimbursement rates, builds relationships with governmental agencies and managed care entities, monitors managed care policy and provider manual changes, negotiates Medicaid contracts and supplemental funding, and assists the Finance Department with assigned projects and disproportionate share matters. Prime Healthcare is an award-winning health system headquartered in Ontario, California, operating 51 hospitals and more than 360 outpatient locations across 14 states. The organization has nearly 57,000 employees and physicians. This is a full-time, day-shift position.
Requirements
- At least 10 years of related experience.
- Bachelor’s degree required.
- In-depth knowledge of managed care concepts, practices, and procedures.
- Strategic thinking and goal orientation.
- Ability to work independently.
- Excellent communication and presentation skills.
Nice To Haves
- Master’s degree in a related field.
- Payer and provider experience.
Responsibilities
- Develop and implement managed care strategies for the organization.
- Develop and implement alignment models, including pay-for-performance, bundled-payment, and risk-contracting arrangements.
- Negotiate and administer contracts with managed care payers.
- Plan, evaluate, and implement managed care programs through negotiations with managed care entities.
- Assess and structure reimbursement rates for managed care contracts.
- Develop relationships with governmental agencies and managed care entities.
- Review, monitor, and disseminate changes to managed care plan policies and provider manuals.
- Negotiate Medicaid contracts and supplemental funding.
- Assist the Finance Department with assigned projects and disproportionate share matters.
Benefits
- Paid time off.
- 401(k) retirement plan.
- Medical coverage.
- Dental coverage.
- Vision coverage.
- Tuition reimbursement.
- Other voluntary benefit options.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Executive
