Serves as the essential Leader and focuses on the strategic and operational of the Health Plan. Provides daily oversight of the Health Plan operations and supports the company’s program management, quality management, and product management. Responsible for the management of the medical claims processing, third party administration, related services contracts, the Medicaid/Medicare contracts, the enrollment/eligibility contracts, billing contracts, third party liability contracts, and any other contracts required to support operations of the Health Plan.
Minimum Job Requirements:
Bachelor’s degree in Health Care Administration, Business Administration or related field required.
10+ years of experience in managed care network development and provider relations/contracting management in a health care and/or managed care environment.
3-5 years of experience in managing, directing and supervising a provider relations staff.
Work experience with medical insurance industry, especially Medicaid and Medicare Company lines of business.
Prior experience in healthcare strategic planning, project management, financial analysis, and managed care principles.
Prior experience in promoting positive business relationships, both internal and external to the business.
At Nicklaus Children’s Hospital, we are driven. Everything we do revolves around one central purpose, to provide the best pediatric care. To achieve this, we strive to be the best in medicine, the best in research and technology and the best hospital of the community. Being the best requires passion, direction and purpose. Because at Nicklaus Children’s Hospital, impacting the lives of children a...nd their families is as much a part of who we are as it is what we stand for. We are Purpose. We are Nicklaus Children's Hospital; Miami Children's Health System.