Director, Payer Contracting - La Jolla

Director position is eligible for new hire incentives

Participates in the Director Incentive Plan.

Located in La Jolla, San Diego and requires you to be a resident of San Diego County.

Elevate your career with Scripps Health, where Compassion Meets Excellence.

Invest, Empower & Belong. At Scripps Health, your potential is limitless. We're more than a healthcare provider, at Scripps you will join a community where your views, beliefs and values are celebrated. Grow through industry-leading development programs and empower yourself to deliver innovative care. Be a part of an extraordinary team, impacting health in beautiful San Diego.

Why join Scripps Health?

AWARD-WINNING WORKPLACE:

At Scripps Health, your ambition is empowered, and your abilities are appreciated:

• Nearly a quarter of our employees have been with Scripps Health for over 10 years.
• Scripps is a Great Place to Work Certified company for 2025.
• Scripps Health has been consistently ranked as a top employer for women, millennials, diversity, and as an overall workplace by various national publications.
• Beckers Healthcare ranked Scripps Health on its 2024 list of 150 top places to work in health care.
• We have transitional and professional development programs to create a learning environment that enables you to thrive in your specific field as well as in your overall career.
• Our specialties have been nationally recognized for quality in areas such as cardiovascular care, oncology, orthopedics, geriatrics, obstetrics and gynecology, and gastroenterology.

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 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 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 to support its negotiating position.
• Communicate with health plans upon acquisition of hospitals, ancillary facilities, and medical groups 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.

In lieu of degree, seven (7) 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.