VP Managed Care in Denville, NJ at Prime Healthcare

Date Posted: 10/14/2019

Job Snapshot

Job Description


Prime Healthcare is an award-winning health system operating 45 hospitals in 14 states. It is one of the nation's leading healthcare service providers with more than 43,500 employees and physicians dedicated to providing the highest quality healthcare. We believe that "all healthcare is local." Explore a hospital in your community.


Our New Jersey CBO is located in Devnille, NJ.


Vice President of Managed Care is essential to the success and financial stability of Prime Healthcare through the development and enhancement of relationships with health plans and other Payors to secure optimal reimbursement and protect the interests of Prime Healthcare through the development, implementation, interpretation and administration of managed care contracts. Leads the planning and creation of the managed care strategy in specific market areas designed to help health plans and other payers move forward. Develops all managed care initiatives, goals and activities including, but not limited to Hospitals and Medical Groups. Collaborates with Physician and other leadership to plan, evaluate and negotiate various fee for-service, value-based and risk contracts.

Manages the design, implementation, and maintenance of managed care plans, and analytics. Provides a written scope of services, departmental policies, and procedures that guide and support the provision and integration of contracts. Monitors quality and healthcare cost performance improvement activity as it relates to contract reimbursement. Develops relationships at the C Suite level with managed care organizations. Monitors market for legal and regulatory developments in Healthcare as it relates to changes in the Payor landscape. Represents the organization in a positive, professional manner in the community and among other Managed Care and related professional organizations.




Experience operating consistent Joint Operations Committee MeetingExperience with Reimbursement/Claims Settlements10-15 years of managed care experience, including contracting, provider and payer relations, account management, business development and growth related functions.


We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.  EEO is the Law: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf