Director, Payer Contracting – La Jolla

Facility: Scripps Health Corp

Location: San Diego, CA

Career Area: Finance

Employment Type: Full Time

Shift: Day

Job ID: 242005600

Share this Job:

Let’s Get Started

Scripps Health Administrative Services supports our five hospital campuses, 31 outpatient centers, clinics, emergency rooms, urgent care sites, along with our 17,000 employees, more than 3,000 affiliated physicians and 2,000 volunteers.

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.

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.

Position Pay Range: $66.73-$96.94/hour

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.

Continue to Application

Similar Jobs

Director, HMO Claims Services
Finance
San Diego, CA
Posted: 100 days ago

About Us

At Scripps, we seek dedicated, compassionate people to join our team and make a significant impact on the health of our community and the future of healthcare. Throughout our five hospital campuses, 30 outpatient centers and clinics, and hundreds of affiliated physician offices throughout the region, each member of our team plays a key role in our life-changing and life-saving mission. Scripps Health is the only San Diego-based company to make Fortune magazine’s 100 Best Places to Work. Our people and their commitment to the highest standards of care are what define us.

Exterior of Scripps Mercy Hospital

Join Our Talent Community

Experience an even greater sense of belonging as a member of the Scripps Talent Community. You’ll receive job alerts with new opportunities that match your interests and other relevant information that will aid your career search. You’ll even be able to share openings with friends through social media and email.

Join Our Talent Community

Experience an even greater sense of belonging as a member of the Scripps Talent Community. You’ll receive job alerts with new opportunities that match your interests and other relevant information that will aid your career search. You’ll even be able to share openings with friends through social media and email.

Awards

Certified Great Place to Work Designation
Fortune Top 100 Hospitals Award
American Heart Association 2024 Get with the Guidelines Designation for Stroke Care Gold Plus Stroke Honor Roll Elite Advanced Therapy