Why join Scripps Health?
AWARD-WINNING WORKPLACE:
* #5 in Fortune Best Workplaces in Health Care 2023
* #78 in 2023 PEOPLE Companies that Care
* #95 in Fortune 100 Best Companies to Work for 2023
* 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 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
* 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.
oEnsures 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.
oSupports 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.
oApplies financial and analytic acumen to work in order to achieve outcomes.
oSupports physician network development and joint venture development through planning and payer contract support.
oMaintain close working relationship with affiliated physicians and groups, including joint contracting, planning, and joint ventures.
oWorks with management to ensure that the staff is appropriately trained in order to maintain the highest level of effectiveness and efficiency.
oAs appropriate, plays an advocacy role in the community as it relates to such issues as managed care regulations and government program reimbursement.
oEnsures regional compliance with local, state and federal regulations and standards.
oIs a member of executive leadership and promotes system wide strategies.
oPerforms other duties as assigned by the Executive Vice President, Chief Growth Officer.
This Vice President position is located at Scripps Health Administrative corporate office in La Jolla.
Required Education/Experience/Specialized Skills: