Regional Vice President, Managed Care

Saint Clare's Health; Denville (NJ); On-site; USD 136,656 - 250,000; Full time

Job summary

Prime Healthcare is seeking a Regional Vice President, Managed Care to lead the development and implementation of managed care strategies across the NJ, PA, and RI markets. You will negotiate and administer contracts with managed care payers, including pay-for-performance and bundled-payment models.

The role requires 10+ years of managed care experience, strong leadership, and excellent communication. This is a full-time, on-site position with no remote option; compensation includes a broad

Qualifications

• At least 10 years related experience.
• In depth knowledge of managed care concepts, practices and procedures.
• Master's degree in related field preferred.
• Strategic thinker, goal oriented, ability to work independently.
• Excellent communication and presentation skills.

Responsibilities

• Develops and implements managed care strategies for the organization.
• Negotiates and administers contracts with managed care payers.
• Plans, evaluates, and implements managed care programs through contract negotiations.
• Contracts focused on NJ, PA, and RI markets; may support other regions as needed.

Skills

Managed care knowledge

Communication skills

Strategic thinking

Independent work

Presentation skills

Education

Master's degree preferred

Job description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Responsibilities

The Regional Vice President, Managed Care will develops and implement the 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 the various managed care programs through the negotiation of contracts with various Managed Care companies.

Regional Executive will be responsible for contracts in the NJ, PA, and RI markets, and may lend to support other regions based on business needs.

Key Responsibilities & Duties

• Assesses and structures rate reimbursement levels for Managed Care Contracts.
• Develops relationships with Governmental Agencies and Managed Care Entities.
• Reviews, monitors, and disseminates changes with regard to Managed Care plan policy and provider manual changes.
• Negotiates Medicaid Contracts and Supplemental Funding.
• Assists Finance Department in projects assigned and disproportionate share.

This role is required at a Prime facility within New Jersey. Remote is not offered.

Qualifications

Required qualifications

• At least 10 years related experience.
• In depth knowledge of managed care concepts, practices and procedures.
• Master's degree in related field preferred.
• Strategic thinker, goal oriented, ability to work independently.
• Excellent communication and presentation skills.

Preferred Qualifications

• Payer and provider experience preferred.

Pay Transparency

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $136,656.00 to $250,000.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf