Vice President - Managed Care - FT - Days - MHS

CO010 Memorial Healthcare System; United States; On-site; USD 180,000 - 280,000; Full time

Job summary

Memorial Healthcare System is seeking a corporate-level leader to execute enterprise-wide strategic and tactical initiatives in complex negotiations with major national and regional payors for the health system’s services.

The role oversees contract negotiations, revenue optimization, and the implementation of financial reimbursement models across hospitals and affiliated networks, reporting to executive leadership and aligning with organizational goals.

Qualifications

• Ten (10) years’ progressive leadership experience in managed care required.
• Payer and provider experience preferred.
• Bachelor’s degree in Business Administration, Finance, Accounting, or in a job related field.

Responsibilities

• Develops and leads strategy to preserve and enhance net revenues.
• Assures financial viability of contracts by leading financial analysis and forecasting in conjunction with Financial Analyst(s), contract negotiations and issue resolution.
• Develops, leads and executes strategies to protect and build market share using industry and utilization trends to strategically allocate revenue within plan contracts accordingly.
• Participates in health plan litigation and development of related strategies, including communications with legal counsels, depositions, discovery and testifying on contract language.
• Leads, executes and monitors managed care contracting strategies for complex language negotiations to drive a positive financial trend and achieve market price points for all service lines.

Skills

Strategic negotiation

Financial analysis

Leadership

Executive decision‑making

Change leadership

Strategic alignment

Education

Bachelor’s degree in Business Administration, Finance, Accounting

Bachelor’s degree (Required)

Job description

Location

Fort Lauderdale, Florida

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Summary

Corporate-level leader responsible for executing enterprise-wide strategic and tactical initiatives for complex negotiations with major national and regional payors on behalf of the health system’s acute care, ancillary and professional providers. Manages execution and communication of contracting initiatives for integrated delivery system and clinically integrated network to drive positive financial trend and to achieve an appropriate market price point for over two billion dollars in contract revenue. Responsible for securing negotiations of all contractual provisions, evaluating and implementing appropriate financial reimbursement models and supporting operations by collaborating with clinical and administrative leadership to enhance revenue and address payer imposed challenges. Creates, guides and implements strategic and tactical initiatives to achieve organization and department goals.

Responsibilities

Develops and leads strategy to preserve and enhance net revenues.

Assures financial viability of contracts by leading financial analysis and forecasting in conjunction with Financial Analyst(s), contract negotiations and issue resolution.

Develops, leads and executes strategies to protect and build market share using industry and utilization trends to strategically allocate revenue within plan contracts accordingly.

Participates in health plan litigation and development of related strategies, including communications with legal counsels, depositions, discovery and testifying on contract language.

Leads, executes and monitors managed care contracting strategies for complex legal, financial and operational contract language negotiations to drive a positive financial trend and achieve an appropriate market price point for all service lines in Memorial Healthcare System’s (MHS) hospitals, Atlantic Coast Health Network (clinically integrated network), Memorial Health Network (clinically integrated network), MHS employed physicians, transplant programs (including subcontracting hospital-based groups), and ancillary services (ambulatory surgical centers, skilled nursing facility, rehabilitation facility, home health, home infusion, urgent care centers, sleep labs and other components) of the clinically integrated healthcare delivery system, and its jointly-owned or joint-ventured entities for fee‑for‑service and value based agreements (capitation, bundled payments, pay for performance, shared savings, shared risk and full risk agreements).

Directs and monitors financial performance of negotiations with major national and regional payors to ensure financial viability of contractual arrangements, achievement of goals, quality metrics and cost savings.

Monitors and researches insurance industry activities, healthcare reform, payer strategies, emerging market demands, and legislative considerations and changes to the managed care industry to devise and achieve a competitive position.

Leads and directs the strategic development and implementation of new product lines and alternative payment methods. Monitors the performance for expected results and adjusts strategies as needed.

Leads and monitors operational issues from Managed Care Revenue Optimization, Accounts Receivable Management, or Joint Operations for solution or potential dispute resolution.

Advises and supports optimal operational performance by collaborating with other departments and facility leadership impacted by payer organizations polices for authorization, denials, discharge planning, pharmaceutical programs, etc. Communicates information and coordinates with leadership to resolve issues.

Initiates, develops and presents managed care financial presentations for department and executive leadership.

Communicates managed care strategy and initiatives throughout with leadership to ensure a cohesive application of strategy execution.

Directs and monitors department operations, activities, resources to meet budget and goals.

Leads, directs, and guides staff in deployment and execution of initiatives, goals and plans.

Plans and monitors activities of staff and/or team members including hiring, orienting, training, mentoring, continuing education, evaluating, coaching and disciplinary actions, as applicable.

Competencies

Achieve Quality & Excellence, Executive Decision‑Making, Leadership Courage, Leading Change, Strategic Alignment Education and Certification Requirements: Bachelors (Required)

Education Requirements

Bachelors (Required)

Additional Education Information

Bachelor’s degree in Business Administration, Finance, Accounting , or in a job related field

Required Work Experience

Ten (10) years’ progressive leadership experience in managed care required. Payer and provider experience preferred.

Working Conditions and Physical Requirements

Bending and Stooping = 0%

Climbing = 0%

Keyboard Entry = 60%

Kneeling = 0%

Lifting/Carrying Patients 35 Pounds or Greater = 0%

Lifting or Carrying 0 - 25 lbs Non-Patient = 40%

Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%

Lifting or Carrying > 75 lbs Non-Patient = 0%

Pushing or Pulling 0 - 25 lbs Non-Patient = 40%

Pushing or Pulling 26 - 75 lbs Non-Patient = 0%

Pushing or Pulling > 75 lbs Non-Patient = 0%

Reaching = 60%

Repetitive Movement Foot/Leg = 0%

Repetitive Movement Hand/Arm = 60%

Running = 0%

Sitting = 60%

Squatting = 0%

Standing = 60%

Walking = 60%

Audible Speech = 60%

Hearing Acuity = 60%

Smelling Acuity = 0%

Taste Discrimination = 0%

Depth Perception = 60%

Distinguish Color = 60%

Seeing - Far = 60%

Seeing - Near = 60%

Bio hazardous Waste = 0%

Biological Hazards - Respiratory = 0%

Biological Hazards - Skin or Ingestion = 0%

Blood and/or Bodily Fluids = 0%

Communicable Diseases and/or Pathogens = 0%

Asbestos = 0%

Cytotoxic Chemicals = 0%

Dust = 0%

Gas/Vapors/Fumes = 0%

Hazardous Chemicals = 0%

Hazardous Medication = 0%

Latex = 0%

Computer Monitor = 60%

Domestic Animals = 0%

Extreme Heat/Cold = 0%

Fire Risk = 0%

Hazardous Noise = 0%

Heating Devices = 0%

Hypoxia = 0%

Laser/High Intensity Lights = 0%

Magnetic Fields = 0%

Moving Mechanical Parts = 0%

Needles/Sharp Objects = 0%

Potential Electric Shock = 0%

Potential for Physical Assault = 0%

Radiation = 0%

Sudden Decompression During Flights = 0%

Unprotected Heights = 0%

Wet or Slippery Surfaces = 0%

Shift: Primarily for office workers - not eligible for shift differential

Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification. Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process. Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity. Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law. We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program. Employment is subject to post offer, pre-placement assessment, including drug testing. If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email [e-mail] Be where care matters. At Memorial Healthcare System, we are dedicated to improving the health, well-being, and quality of life of the people entrusted to our care.

Veteran’s Preference

Memorial Healthcare System provides preference as part of our commitment to honoring the service and sacrifice of veterans in alignment with state regulations. Veteran’s Preference allows for the first choice in interviewing, hiring, retention, and promotion after deployment when all other applicant qualifications are equal. However, Veteran's Preference does not guarantee a job. Who is eligible for Veteran’s Preference? We are proud to offer preference to internal and external applicants who identify within these categories: veterans, disabled veterans, spouse of a disabled veteran, unremarried veteran widow/widower, certain family members, active reservists and members of the National Guard. What should I do if I am eligible for Veteran’s Preference? You must claim your Veteran’s Preference status on your application. If selected for a job, you must provide documentation regarding your status. How does Memorial verify that someone is eligible for Veteran’s Preference? We require specific documentation as determined by the basis for which someone claims preference. For example, the documentation for a disabled veteran is different from the documentation required for the spouse of a veteran killed in the line of duty. How often can an eligible person claim Veteran's Preference at Memorial? There is no limit to how often internal or external applicants can use preference when a job is posted externally on our career website or elsewhere. What if there are two equally qualified, preference-eligible job applicants? In this case, the selection is based on the eligibility category in accordance with Florida law. First preference is given to: An honorably discharged veteran who has served on active duty and has a service-connected, compensable disability. A spouse of a person who has a total, permanent, service-connected disability and cannot qualify for employment. A spouse of a person missing in action, captured or forcibly detained or interned by a foreign government or power.

EEO/DEI Statement

Florida Civil Rights Act Equal Employment Opportunity is the Law (EEO) Family and Medical Leave Act (FMLA) Employee Polygraph Protection Act (EPPA) E-Verify™ Participation Notice – English Right To Work Notice – English E-Verify™ Participation Notice – Spanish Right To Work Notice – Spanish Memorial Healthcare System is subject to the Florida Public Records Law. All information provided in connection with your application for employment will be a public record and subject to release upon request, unless considered exempt or confidential.

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Be where care matters. At Memorial Healthcare System, we are dedicated to improving the health, well-being, and quality of life of the people entrusted to our care. This unwavering commitment to our service vision makes the difference and is the foundation of The Memorial Experience. Deeper Caring. Smarter Healthcare. Talk to our patients and their families about “Deeper Caring,” and they'll tell you stories about miracle babies, lives saved through sheer determination, and the comforting kindness of others. For our employees, “Smarter Healthcare” means constantly improving how we deliver care. It could be a new technology, a streamlined process, or a cutting‑edge program leveraging our system strengths. But, no matter how you look at it, our service vision is integral to our culture today and what we strive to be tomorrow.