Vice President, Managed Care

Overview

At Saint Clare's Health, our dedicated team of professionals is committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, Saint Clare's Health is actively seeking new members to join its award-winning team!

Saint Clare's Health includes CMS 5-Star Rated hospitals and is an award-winning provider of safe, high quality, compassionate care, serving the communities of Morris, Warren and Sussex counties. Its network of hospitals and healthcare facilities include Denville Hospital, Dover Hospital, Behavioral Health Centers in Boonton, Denville, and Parsippany, and an Imaging Center in Parsippany, among other satellite locations. The hospitals have received multiple quality awards including Leapfrog “A” ratings for patient safety; Healthgrades recognition for orthopedic surgery, treatment of stroke, heart care, various surgical procedures, and more. For information, visit www.saintclares.com.

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Responsibilities

Vice President of Managed Care is essential to the success and financial stability of Prime Healthcare through the development and enhancement of relationships with health plans and other Payors to secure optimal reimbursement and protect the interests of Prime Healthcare through the development, implementation, interpretation and administration of managed care contracts. Leads the planning and creation of the managed care strategy in specific market areas designed to help health plans and other payers move forward. Develops all managed care initiatives, goals and activities including, but not limited to Hospitals and Medical Groups. Collaborates with Physician and other leadership to plan, evaluate and negotiate various fee for-service, value-based and risk contracts. Manages the design, implementation, and maintenance of managed care plans, and analytics. Provides a written scope of services, departmental policies, and procedures that guide and support the provision and integration of contracts. Monitors quality and healthcare cost performance improvement activity as it relates to contract reimbursement. Develops relationships at the C Suite level with managed care organizations. Monitors market for legal and regulatory developments in Healthcare as it relates to changes in the Payor landscape. Represents the organization in a positive, professional manner in the community and among other Managed Care and related professional organizations.

Qualifications

1. Experience operating consistent Joint Operations Committee Meeting2. Experience with Reimbursement/Claims Settlements3. 10-15 years of managed care experience, including contracting, provider and payer relations, account management, business development and growth related functions.

Pay Transparency

Saint Clare's Health offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.  Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary.  A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $225,000.00 to $260,000.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

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Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf