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DIRECTOR, PAYOR CONTRACTING

Scripps Health San Diego Full-Time
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Description

Change Lives, Starting with Yours.


At Scripps Health, you will experience the pride, support, respect that has been repeatedly recognized as one of the nation’s Top 100 Places to work.

You’ll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if you’re open to change, go ahead and unlock your potential.



For the second year in a row, U.S. News & World Report has rated Scripps Health as No. 1 in San Diego, No. 6 in California and among the best in the nation in multiple specialties.



As Director, Payor Contracting, you will proactively support the Mission, Vision, Philosophy and Values of the Scripps Health organization and be sensitive and responsive to the unique cultures and deeds of the assigned business unit.



You will negotiate fee-for-service, shared risk and global risk HMO, PPO and Ancillary services managed care agreements with health plans on behalf of Scripps Health's hospitals/facilities. The Scripps Medical Foundation and partner medical groups in order to achieve Scripps Health's targeted revenue increases and overall goals.



Play an integral role in overseeing the analysis, management, accounting and budgeting of all managed care agreements. Establish effective lines of communications between Payor Relations and Patient Financial Services, Business Services and Scripps Health Plan Services in order to maximize contract effectiveness and ease of administration. Negotiate settlements and resolves disputes between Scripps Health, Scripps Health Plan Services and our contracted health plans.



Additionally, you will present the results to all levels of management at Scripps Health and Scripps Health Plan Services in order to support its negotiating position. Communicates with health plans upon acquisition of hospitals, ancillary facilities and medical groups in order to include them in HMO, PPO and Ancillary services managed care agreements. Participate in strategy development for Scripps Health/Scripps Health Plan Services.



This Director position is located in La Jolla.




Qualifications

Required Education/Experience/Specialized Skills:

  • Bachelor's degree.
  • Five (5) years of management experience in hospital and medical group fee-for-service, shared risk and global risk HMO, PPO and ancillary services negotiations and contracting experience, including strong knowledge of legal and financial issues.


Preferred Education/Experience/Specialized Skills/Certification:
  • Master's degree in business or health care administration or related field.
  • Eight (8) years of hospital and medical group fee-for-service, shared risk full global risk HMO, PPO and ancillary services negotiations and contracting experience.
  • Strong financial modeling and analytic skills and experience overseeing this function in the a multi-institutional/medical group setting.
*LI-SH1





Scripps Health is repeatedly named on the Fortune Magazine’s 100 Best Companies to work for, only San Diego-based Company and Becker’s Healthcare Top Hospitals. Scripps Health offers a robust Total Rewards Program designed to compensate and motivate you throughout your career. Scripps Health Total Rewards Program includes a broad range of plans and programs including market competitive pay and performance incentives, health and wellness benefits, financial wellness benefits, work-life resources, learning and development opportunities, and rewards and recognition. Unlock your potential with Scripps Health today.

Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.

Job: Leadership - Administrative
Primary Location: Central San Diego County-SAN DIEGO-SCRIPPS CORPORATE OFFICES
Work Locations:
SCRIPPS CORPORATE OFFICES (100_100)
4275 CAMPUS POINT COURT
SAN DIEGO, 92121


Organization: Scripps Health Corp
Job Posting: Jun 7, 2019, 2:45:00 PM
Benefit Status: FT - FULL-TIME WITH BENEFITS
 

Skills required

Medicare
Government
Managed Care
Claims
Medicaid
Negotiation
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Job ID: 1034764

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At Scripps, we’re interested in people who are interested in new possibilities.

Whether you are looking for a new career opportunity or looking for care for yourself or a family member, you’ll find what you need at Scripps. Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps is a nonprofit health system located in San Diego, California. We treat more than 700,000 patients annually through the dedication of 3,000 affiliated physicians and more than 15,000 employees among our five acute-care hospital campuses, hospice and home health care services, 30 outpatient centers and clinics, and hundreds of affiliated physician offices throughout the region.

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