Sr VP - Managed Care
Memorial Healthcare System
Date: 3 weeks ago
City: Hollywood, FL
Contract type: Full time
Location:
Hollywood, Florida
At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.
Summary
Responsible for enterprise-wide strategic development and tactical leadership of Managed Care Contracting & Operations and Managed Care Compliance Departments. Monitors performance of staff to achieve the organization's mission, directives and goals.
Responsibilities
Monitors and prepares budgets for these areas.Develops and analyzes monthly financial packages for presentation to executives.Manages all aspects of lawsuits, arbitration, mediation and settlements.Participates in complex negotiations with national payers to ensure financial viability of contractual arrangements and achievement of goals.Reviews and monitors contract compliance reports to assure achievement of goals.Works closely with managed care staff to develop and implement strategies for all entities and monitors progress and outcomes.Works with health plan executives to overturn appeals and address Contract Compliance trends, issues and payments.Collaborates with executive leadership to develop current and future strategies for the organization. Researches and monitors insurance industry activities, healthcare reform, payer strategy and participates in legislative committees to gain knowledge in potential state and federal impacts.
Competencies
Education and Certification Requirements:
Bachelors (Required)
Additional Job Information
Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Must be able to manage team towards achievement of strategic goals. Must be able to communicate departmental strategy throughout organization. Must have working knowledge of value based care and financial risk arrangements. Must possess broad industry knowledge, preferably based on payer and provider experience, to develop and execute complex managed care negotiation and collections strategies. Required Work Experience: Ten (10) years' experience in managed care, preferably with local market knowledge. Payer and provider experience preferred. Other Information: Additional Education Info: Bachelor's degree in Business Administration, Finance, Accounting, or in a job related field.
Working Conditions And Physical Requirements
Primarily for office workers - not eligible for shift differential
Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.
Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.
Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.
Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.
We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.
Employment is subject to post offer, pre-placement assessment, including drug testing.
If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email [email protected]
Hollywood, Florida
At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.
Summary
Responsible for enterprise-wide strategic development and tactical leadership of Managed Care Contracting & Operations and Managed Care Compliance Departments. Monitors performance of staff to achieve the organization's mission, directives and goals.
Responsibilities
Monitors and prepares budgets for these areas.Develops and analyzes monthly financial packages for presentation to executives.Manages all aspects of lawsuits, arbitration, mediation and settlements.Participates in complex negotiations with national payers to ensure financial viability of contractual arrangements and achievement of goals.Reviews and monitors contract compliance reports to assure achievement of goals.Works closely with managed care staff to develop and implement strategies for all entities and monitors progress and outcomes.Works with health plan executives to overturn appeals and address Contract Compliance trends, issues and payments.Collaborates with executive leadership to develop current and future strategies for the organization. Researches and monitors insurance industry activities, healthcare reform, payer strategy and participates in legislative committees to gain knowledge in potential state and federal impacts.
Competencies
Education and Certification Requirements:
Bachelors (Required)
Additional Job Information
Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Must be able to manage team towards achievement of strategic goals. Must be able to communicate departmental strategy throughout organization. Must have working knowledge of value based care and financial risk arrangements. Must possess broad industry knowledge, preferably based on payer and provider experience, to develop and execute complex managed care negotiation and collections strategies. Required Work Experience: Ten (10) years' experience in managed care, preferably with local market knowledge. Payer and provider experience preferred. Other Information: Additional Education Info: Bachelor's degree in Business Administration, Finance, Accounting, or in a job related field.
Working Conditions And Physical Requirements
- Bending and Stooping = 0%
- Climbing = 0%
- Keyboard Entry = 60%
- Kneeling = 0%
- Lifting/Carrying Patients 35 Pounds or Greater = 0%
- Lifting or Carrying 0 - 25 lbs Non-Patient = 40%
- Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%
- Lifting or Carrying > 75 lbs Non-Patient = 0%
- Pushing or Pulling 0 - 25 lbs Non-Patient = 40%
- Pushing or Pulling 26 - 75 lbs Non-Patient = 0%
- Pushing or Pulling > 75 lbs Non-Patient = 0%
- Reaching = 60%
- Repetitive Movement Foot/Leg = 0%
- Repetitive Movement Hand/Arm = 60%
- Running = 0%
- Sitting = 60%
- Squatting = 0%
- Standing = 60%
- Walking = 60%
- Audible Speech = 60%
- Hearing Acuity = 60%
- Smelling Acuity = 0%
- Taste Discrimination = 0%
- Depth Perception = 60%
- Distinguish Color = 60%
- Seeing - Far = 60%
- Seeing - Near = 60%
- Bio hazardous Waste = 0%
- Biological Hazards - Respiratory = 0%
- Biological Hazards - Skin or Ingestion = 0%
- Blood and/or Bodily Fluids = 0%
- Communicable Diseases and/or Pathogens = 0%
- Asbestos = 0%
- Cytotoxic Chemicals = 0%
- Dust = 0%
- Gas/Vapors/Fumes = 0%
- Hazardous Chemicals = 0%
- Hazardous Medication = 0%
- Latex = 0%
- Computer Monitor = 60%
- Domestic Animals = 0%
- Extreme Heat/Cold = 0%
- Fire Risk = 0%
- Hazardous Noise = 0%
- Heating Devices = 0%
- Hypoxia = 0%
- Laser/High Intensity Lights = 0%
- Magnetic Fields = 0%
- Moving Mechanical Parts = 0%
- Needles/Sharp Objects = 0%
- Potential Electric Shock = 0%
- Potential for Physical Assault = 0%
- Radiation = 0%
- Sudden Decompression During Flights = 0%
- Unprotected Heights = 0%
- Wet or Slippery Surfaces = 0%
Primarily for office workers - not eligible for shift differential
Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.
Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.
Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.
Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.
We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.
Employment is subject to post offer, pre-placement assessment, including drug testing.
If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email [email protected]
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