Job DescriptionJob Summary:
Assumes responsibility for Health Plan (managed care) contracting, payer in-servicing, contract implementation and contract reporting across the system. Works in association with the both the corporate and hospital leadership on contract matters. Serves as liaison between the organizations facilities and physicians with affiliated health plans, independent practice associations (IPAs) and other payers. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment.
Job Requirements:
Education and Work Experience:
- Bachelor's Degree or equivalent combination of education/related experience: Required
- Master's degree: Preferred
- Seven years' related experience: Preferred
- Five years' leadership experience: Preferred
Essential Functions:
- Maintains focus negotiations responsibility for payer relationships including market parity for contract negotiations for Adventist Health hospitals, surgery centers, home health, hospice, long term care facilities, Adventist Health Physician Network, rural health clinics and other Adventist Health affiliated physician organizations.
- Manages, directs, and leads the departmental staff to ensure maximum productivity and efficiency. Plans/monitors/maintains, FTE, capital, and operational budgets. Reviews department systems, concerns, budgets, and goals with leadership, including cost reduction and revenue enhancement.
- Uses comprehensive knowledge of health plan industry with the ability to review and articulate industry financial and claims data points to both external and internal key stakeholders.
- Exercises independent judgment in recruiting, training, coaching, supervising and responsibly directing assigned staff. Directs, organizes, and plans the operation of assigned department at the center and market level.
- Ensures compliance with health plan and payer contracts, and local, state, and federal regulations.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
