VP Managed Care in Plano, TX at Prime Healthcare

Date Posted: 11/14/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    5212 Tennyson Parkway
    Plano, TX
  • Experience:
    10 to greater than 15 years
  • Date Posted:
    11/14/2019

Job Description



Responsibilities

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.

Qualifications

 


  • Experience operating consistent Joint Operations Committee Meeting

  • Experience with Reimbursement/Claims Settlements

  • 10-15 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