Regional Vice President, Managed Care Contracting

Prime Healthcare; Chicago (IL); On-site; USD 134,000 - 194,000; Full time

Job summary

Prime Healthcare is seeking a Regional VP, Managed Care to lead and execute the organization\'s managed care strategy across payers and programs. The role focuses on negotiating contracts, shaping reimbursement models, and aligning strategies with financial goals.

Ideal candidate has 10+ years in managed care, an advanced degree preferred, and a proven ability to build relations with government agencies and payers, while communicating clearly with executives and clinical leadership.

Qualifications

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

Responsibilities

• 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.

Skills

Managed care knowledge

Strategic thinking

Independent work

Presentation skills

Communication skills

Education

Bachelor's degree

Master's degree preferred

Job description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation’s leading health systems with nearly 57,000 employees and physicians. Eighteen 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 corpora

Responsibilities

The Regional VP, 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 entities.

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.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required Qualifications

• At least 10 years related experience.
• Minimum of Bachelor's degree required.
• Master's degree in related field preferred.
• In depth knowledge of managed care concepts, practices and procedures.
• 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 $134,160 to $194,313 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