Regional Vice President, Managed Care

Prime Healthcare•Denville, NJ

11d•Onsite

About The Position

Prime Healthcare is an award-winning health system headquartered in Ontario, California, operating 54 hospitals and over 360 outpatient locations across 15 states. With more than 3.0 million patient visits annually, it is one of the nation's leading health systems, employing over 60,000 individuals. Twenty-one of its hospitals are part of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join its corporate team.

Requirements

At least 10 years related experience.
In-depth knowledge of managed care concepts, practices, and procedures.
Strategic thinker, goal-oriented, ability to work independently.
Excellent communication and presentation skills.

Nice To Haves

Master's degree in a related field preferred.
Payer and provider experience preferred.

Responsibilities

Develops and implements managed care strategies for the organization.
Develops and implements alignment models such as pay for performance, bundled payments, and various forms of risk contracting.
Negotiates and administers contracts with managed care payers.
Responsible for planning, evaluating, and implementing various managed care programs through contract negotiation with Managed Care companies.
Responsible for contracts in the NJ, PA, and RI markets, and may support other regions based on business needs.
Assesses and structures rate reimbursement levels for Managed Care Contracts.
Develops relationships with Governmental Agencies and Managed Care Entities.
Reviews, monitors, and disseminates changes regarding Managed Care plan policy and provider manual changes.
Negotiates Medicaid Contracts and Supplemental Funding.
Assists Finance Department in assigned projects and disproportionate share.