Job Snapshot
This post is also available in: ims
Job Description
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.
Why join Scripps Health?
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.
Why Payer Relations?
The Payer Relations team is a close-knit group of highly motivated individuals.
We are passionate about our work and love to laugh.
What will you do?
- 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.
In compliance with the California Pay Transparency Act, Scripps Health posts the pay range for all jobs. Please note that actual pay will be determined based on relevant experience and internal equity within the pay range. Please also note this range is applicable for employees who reside in California only. A geographical pay differential may be applied for remote employees who reside out of state. Scripps Health strives to ensure that our employees receive equal pay for equal work in line with our commitment to being an equal opportunity employer.
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.
This post is also available in: ims
Requirements
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:
-
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.
-
Strong financial modeling and analytic skills and experience overseeing this function in a multi-institutional/medical group setting.
This post is also available in: ims
This post is also available in: ims
Similar Jobs
Laura Lettkeman – Manager Clinical Care Line, MD Anderson
2/27/2012
Registered Nurse
Provides direct patient care within the scope of his/her practice. Patient care includes assessment, planning and implementing a plan of care and evaluating patients' progress towards expected outcomes. The RN takes primary responsibility for the patients' care as delivered by the Care Team under his/her supervision.12/4/2014
Supervisor, Patient Care
Ensures nursing practice reflects established standards of care and practice and a culture that promotes patient safety. Under the general direction of the Patient Care Manager, shares leadership responsibilities for the nursing unit, including managing daily staffing plans.3/8/2015
Manager, Patient Care
Creates and maintains an environment that assures nursing practice reflects established standards of care and practice and a culture that promotes patient safety. Responsible for the daily operations of assigned nursing unit. Manages staffing plans to ensure appropriate equipment and resources are available to staff to do their job.3/28/2020
Manager, Clinical Care Line
Assesses and improves the patient care process for the assigned population along the continuum of care, serving as an expert clinical resource for ensuring quality of care and customer satisfaction. Develops competencies for care line staff and may facilitate staff education.2012
2/27/2012
Registered Nurse
Provides direct patient care within the scope of his/her practice. Patient care includes assessment, planning and implementing a plan of care and evaluating patients' progress towards expected outcomes. The RN takes primary responsibility for the patients' care as delivered by the Care Team under his/her supervision.
2014
2015
Current
About Us
Scripps Health is a non-profit health care delivery network dedicated to the community it calls home: San Diego, California. We are:
- Home to 5 hospitals, 30+ outpatient centers and hundreds of affiliated physician offices
- Known for our compassionate, collaborative culture
- The only San Diego-based company to make Fortune magazine’s 100 Best Places to Work
- Consistently ranked by U.S. News & World Report among the nation’s best
- At the forefront of clinical research and education, with three highly respected graduate medical education programs and one of the top teaching hospitals in the nation
Join Our Talent Network
Not ready to apply?
Receive alerts with new job opportunities that match your interests
Receive relevant communications and updates from our organization
Share job opportunities with family and friends through social media and email
This post is also available in: ims
