Vp, Payer Relations Jobs

Scripps Health Administrative Services supports our five hospitals and 19 outpatient facilities, which treat half a million patients annually through 2,600 affiliated physicians.

I. GENERAL PURPOSE

The Vice President, Payer Relations has enterprise level responsibility for providing strategic and operational leadership in the development and execution of all types of payer contracting programs and provider partnership strategies for all lines of business (including commercial, senior, fee for service and value based). This role serves as the face of the system to all payors and their partners. The role will lead a cross functional teams that have substantial impact on quality, revenue and growth across all Scripps Health business units. The Vice President is expected to exercise independent judgment in the day-to-day management of the organization's contracting and managed care activities.

II. DUTIES AND RESPONSIBILITIES

• Ensures achievement of net revenue targets through contract negotiations with Commercial HMO/PPO payers, California Medi-Cal, Medicare Advantage Plans, County Medical Services, TriCare, and other purchasers.
• Supports physician network development and joint venture development through planning and payer contract support.
• Proactively supports the Mission, Vision, Philosophy and Values of the Scripps Health organization and is sensitive and responsive to the unique cultures and deeds of the assigned business unit.
• Works with management to ensure that the staff is appropriately trained in order to maintain the highest level of effectiveness and efficiency.
• Maintain close working relationship with affiliated physicians and groups, including joint contracting, planning, and joint ventures.
• • Ensures achievement of net revenue targets through contract negotiations with Commercial HMO/PPO payers, California Medi-Cal, Medicare Advantage Plans, County Medical Services, TriCare, and other purchasers.
  • Supports business unit-specific and medical group-specific payer contract needs, such as Center of Excellence contracting for tertiary programs, physician relations for program development, and major "wholesale" payer relationships.
  • Applies financial and analytic acumen to work in order to achieve outcomes.
  • Supports physician network development and joint venture development through planning and payer contract support.
  • Maintain close working relationship with affiliated physicians and groups, including joint contracting, planning, and joint ventures.
  • Works with management to ensure that the staff is appropriately trained in order to maintain the highest level of effectiveness and efficiency.
  • As appropriate, plays an advocacy role in the community as it relates to such issues as managed care regulations and government program reimbursement.
  • Ensures regional compliance with local, state and federal regulations and standards
  • Is a member of executive leadership and promotes system wide strategies.
  • Performs other duties as assigned by the Executive Vice President, Chief Growth Officer
• As appropriate, plays an advocacy role in the community as it relates to such issues as managed care regulations and government program reimbursement.
• Applies financial and analytic acumen to work in order to achieve outcomes.
• Performs other duties as assigned by the Executive Vice President, Chief Growth Officer
• Is a member of executive leadership and promotes system wide strategies.
• Ensures regional compliance with local, state and federal regulations and standards
• Supports business unit-specific and medical group-specific payer contract needs, such as Center of Excellence contracting for tertiary programs, physician relations for program development, and major "wholesale" payer relationships.

• In conjunction with peer executives, service line directors and finance prepare operating and capital budgets to ensure that the appropriate resources are allocated and invested to meet the health service delivery needs for assigned business unit.

• Leads, consistent with Scripps management system, the development of key performance indicators, reporting of such and the development of management systems to ensure achievement of such KPIs for business units.

• Responsible for ensuring that established financial and quality goals are achieved

• Participates in the formulation and/or update of the business unit operations and annual strategic plan.

• Directs the formulation and/or update of the annual strategic plans for assigned business unit to fulfill the goals and objectives of the systems strategic plan.

• Meets regularly with clinical staff leadership, the medical consultant, and independent physicians to ensure the integrity of professional and technical aspects of programs and services offered to achieve optimal clinical outcomes, patient satisfaction and efficiencies in resource consumption.

• Maintains productive working relationships.

• Provides the leadership necessary to ensure the business unit is responsive to the continuing healthcare needs of the communities it serves.

• Ensures that the care of patients is of the highest professional quality and meets the standards prescribed by licensing and accrediting bodies of Scripps Health.

• Provides leadership in corporate-sponsored project teams to achieve continuity in the system wide care continuum and supports performance improvement efforts at the business unit.

Required Education/Experience/Specialized Skills:

• Must demonstrate a track record of being an accomplished executive with health care system experience.
• Master's Degree in a related field or an equivalent combination of education and experience.
• Dedication to excellence and innovation regarding continuous quality improvement, patient care models and clinical integration.
• Knowledge and understanding of the driving forces in the local, state, and national healthcare markets and the ability to assess emerging trends and needs and develop plans to address such trends.
• A demonstrated record of and concern for positive employee relations.
• Must be community oriented and committed to the concept of a healthy community.
• Must possess strong leadership skills and be an effective team builder.
• Must possess excellent written, verbal and listening communication skills and be comfortable and effective in working with all levels of management, Board, employees, physicians, the community and donors.
• Must possess a system mindset and be supportive of Scripps Health, understanding the value of being part of a strong system.
• Must evidence a commitment to continuing professional development.
• A seasoned executive with five or more years of operations experience who has demonstrated increasingly responsible experience in healthcare administration.
• Extensive strategic planning and budget formulation skills at an executive level with complex analytical and problem-solving skills.

Knowledge of State and Federal Healthcare regulations including relating to payer contracts, payment guidelines, etc.

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.