The posting
Responsibilities Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Learn more at: https://prominence-health.com/ Job Summary: The Vice President of Operations leads and manages Prominence’s Operations consistent with the strategic goals of Prominence Health. This position is a key part of Prominence’s strategic imperative to achieve its financial performance goals, as well as its goal of building the capacity necessary to support UHS’s clinical integration strategy. The incumbent will take direct responsibility for Prominence Operations with Enrollment, Claims, Configuration, and Customer Service. The incumbent will be responsible for all current lines of business and future lines of business including Medicare Advantage, Commercial, and ASO/Self-Funded. As a member of Prominence’s senior leadership team, the incumbent will be accountable with other senior leaders for achieving Prominence’s financial, quality, and service goals. In addition, the incumbent will represent Prominence in UHS workgroups working on clinical integration and population management. Benefit Highlights: Loan Forgiveness Program Challenging and rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match and discounted stock plan SoFi Student Loan Refinancing Program Career development opportunities within UHS and its 300+ Subsidiaries! · More information is available on our Benefits Guest Website: benefits.uhsguest.com About Universal Health Services: One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com Qualifications Qualifications and Requirements: Education and Experience: Bachelor’s Degree in Business or related Health Care degree, and Master’s in Public Health or MBA. At least eight years of Operations management or consulting experience with at least three year experience in managed care. Commercial specific: Experience with optimizing revenue cycle from rate development to billing and collection Experience with optimizing benefit administration cycle from benefit design to provider contracts and claims Experience with provider networks from reimbursement models (including P4P and capitation) to contracting and their impact on operations Third Party Administration specific: Experience with self-funded groups from benefit design to reinsurance contracts to client reports Medicare Advantage specific: Experience with multi-State Medicare Advantage program Experience with CMS at the strategic and tactical level Experience with delegated entities Strong coordination capabilities to direct and supervise the intersections of Prominence functional areas and delegated entities Capability to build in-house infrastructure to allow outsourced functions being moved in-house Experience to work collaboratively with Compliance Detailed understanding of the bid submission process Detailed understanding of the risk score collection and documentation process Detailed understanding of the Star rating process and demonstrated ability to move Plan toward a 5-star rating Skills: Strong communication, influencing, presentation, and relationship building skills Proficient in Microsoft Office Suite Strategic but practical thinker that can take concepts from its initial stage through implementation to administration Excellent communicator who is equally comfortable with external stakeholders as well as internal stakeholders Demonstrated ability to build a highly functioning team and to mentor direct reports Experience with Commercial, Self-funded, and Medicare Advantage network requirements Proven ability to foster collaboration between divergent stakeholders High degree of credibility with key stakeholders based on past accomplishments Experience in negotiating complex provider reimbursement arrangement and complex third party contracts Adept in managing outsourced vendor relationships in compliance with NCQA and CMS delegated entity rules Comfortable in managing interfaces with Prominence functional areas and third party partners Proven ability to drive organization through cultural change, focused on individual accountability and performance Solid understanding of health plan key financial drivers Service excellence orientation toward external and internal stakeholders EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success. Avoid and Report Recruitment Scams At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.
