Director, Payer Contracting - La Jolla

Director position is eligible for new hire incentives and participates in the Director Incentive Plan.

Located in La Jolla, this is a remote, local position as you are expected to come on-site for meetings and projects as needed.

AWARD-WINNING WORKPLACE:

• Selected as one of the 100 Best Places to Work for 2024 by Fortune Magazine and the Great Place to Work Institute for the 16th time. A remarkable achievement, as only five healthcare organizations nationwide made the list, and Scripps is the sole healthcare provider in California to be recognized.
• Recognized by Newsweek as one of America's Greatest Workplaces for Diversity in 2024.
• Nearly a quarter of our employees have been with Scripps Health for over 10 years.

The Payer Relations team is a close-knit group of highly motivated individuals.
We are passionate about our work and love to laugh.

• Negotiate fee-for-service, partial risk, and full global risk HMO, PPO, and Ancillary services managed care agreements with health plans on behalf of Scripps Health's hospitals/facilities or Scripps Medical Foundation and partner medical groups or a combination of both in order to achieve Scripps Health's revenue targets and overall goals.
• Oversee and actively engage in the analysis, management, accounting, and budgeting of all managed care agreements. Establish effective lines of communication between Payer Relations and Patient Financial Services, Business Services, and Scripps Health Plan Services in order to maximize contract effectiveness and ease of administration.
• Negotiate settlements and resolve disputes between Scripps Health, Scripps Health Plan Services, and third-party payers.
• Present the results to all levels of management at Scripps Health and Scripps Health Plan Services in order to support its negotiating position.
• Communicate with health plans upon acquisition of hospitals, ancillary facilities, and medical groups in order to include them in HMO, PPO, and Ancillary services managed care agreements.
• Participate in strategy development for Scripps Health/Scripps Health Plan Services payer contracting.

Required Education/Experience/Specialized Skills:

• Bachelor's degree plus five (5) years of management experience in hospital and medical group fee-for-service, partial risk, and full global risk HMO, PPO, and ancillary services negotiations and contracting experience, including strong knowledge of legal and financial issues.

Preferred Education/Experience/Specialized Skills/Certification:

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  Master's degree in business or health care administration, or a related field, and eight (8) years of hospital and medical group fee-for-service, partial risk, and full global risk HMO, PPO, and ancillary services negotiations and contracting experience.

  
  
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  Strong financial modeling and analytic skills and experience overseeing this function in a multi-institutional/medical group setting.