Adventist Health
Director, Managed Care Negotiations (Oregon Network)
Adventist Health, Roseville, California, United States, 95678
Overview
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Director, Managed Care Negotiations (Oregon Network)
role at
Adventist Health .
Adventist Health Portland has been one of the area’s leading healthcare providers since the 1800s. In partnership with OHSU, we are comprised of a 302-bed hospital, 11 medical offices, home care services, comprehensive cancer care and a vast scope of award-winning services located throughout East Portland and the surrounding areas. There are many outdoor adventures readily available, including carving the snow at North America’s only year-round ski resort, hiking along the Columbia River Gorge or taking a day trip to the unmatched beauty of the Oregon coast.
Job Summary Assumes responsibility for Health Plan (managed care) contracting, payer in-servicing, contract implementation and contract reporting across the system. Works in association with the both the corporate and hospital leadership on contract matters. Serves as liaison between the organizations facilities and physicians with affiliated health plans, independent practice associations (IPAs) and other payers. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment.
Job Requirements Education and Work Experience:
Bachelor’s Degree or equivalent combination of education/related experience: Required
Master's degree: Preferred
Seven years' related experience: Preferred
Five years' leadership experience: Preferred
Essential Functions
Maintains focus negotiations responsibility for payer relationships including market parity for contract negotiations for Adventist Health hospitals, surgery centers, home health, hospice, long term care facilities, Adventist Health Physician Network, rural health clinics and other Adventist Health affiliated physician organizations.
Manages, directs, and leads the departmental staff to ensure maximum productivity and efficiency. Plans/monitors/maintains, FTE, capital, and operational budgets. Reviews department systems, concerns, budgets, and goals with leadership, including cost reduction and revenue enhancement.
Uses comprehensive knowledge of health plan industry with the ability to review and articulate industry financial and claims data points to both external and internal key stakeholders.
Exercises independent judgment in recruiting, training, coaching, supervising and responsibly directing assigned staff. Directs, organizes, and plans the operation of assigned department at the center and market level.
Ensures compliance with health plan and payer contracts, and local, state, and federal regulations.
Performs other job-related duties as assigned.
Additional Details This position will support the Oregon Network. Position may sit at Roseville, CA, Glendale, CA, or Portland, OR.
Organizational Requirements Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.
About Us Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God\'s love by inspiring health, wholeness and hope.
Position Details
Seniority level: Director
Employment type: Full-time
Job function: Health Care Provider
Industries: Hospitals and Health Care
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Director, Managed Care Negotiations (Oregon Network)
role at
Adventist Health .
Adventist Health Portland has been one of the area’s leading healthcare providers since the 1800s. In partnership with OHSU, we are comprised of a 302-bed hospital, 11 medical offices, home care services, comprehensive cancer care and a vast scope of award-winning services located throughout East Portland and the surrounding areas. There are many outdoor adventures readily available, including carving the snow at North America’s only year-round ski resort, hiking along the Columbia River Gorge or taking a day trip to the unmatched beauty of the Oregon coast.
Job Summary Assumes responsibility for Health Plan (managed care) contracting, payer in-servicing, contract implementation and contract reporting across the system. Works in association with the both the corporate and hospital leadership on contract matters. Serves as liaison between the organizations facilities and physicians with affiliated health plans, independent practice associations (IPAs) and other payers. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment.
Job Requirements Education and Work Experience:
Bachelor’s Degree or equivalent combination of education/related experience: Required
Master's degree: Preferred
Seven years' related experience: Preferred
Five years' leadership experience: Preferred
Essential Functions
Maintains focus negotiations responsibility for payer relationships including market parity for contract negotiations for Adventist Health hospitals, surgery centers, home health, hospice, long term care facilities, Adventist Health Physician Network, rural health clinics and other Adventist Health affiliated physician organizations.
Manages, directs, and leads the departmental staff to ensure maximum productivity and efficiency. Plans/monitors/maintains, FTE, capital, and operational budgets. Reviews department systems, concerns, budgets, and goals with leadership, including cost reduction and revenue enhancement.
Uses comprehensive knowledge of health plan industry with the ability to review and articulate industry financial and claims data points to both external and internal key stakeholders.
Exercises independent judgment in recruiting, training, coaching, supervising and responsibly directing assigned staff. Directs, organizes, and plans the operation of assigned department at the center and market level.
Ensures compliance with health plan and payer contracts, and local, state, and federal regulations.
Performs other job-related duties as assigned.
Additional Details This position will support the Oregon Network. Position may sit at Roseville, CA, Glendale, CA, or Portland, OR.
Organizational Requirements Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.
About Us Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God\'s love by inspiring health, wholeness and hope.
Position Details
Seniority level: Director
Employment type: Full-time
Job function: Health Care Provider
Industries: Hospitals and Health Care
#J-18808-Ljbffr