VP Health Plan Operations Division II


Dallas, TX

Industry: Healthcare


5 - 7 years

Posted 40 days ago

  by    Randy Montz

Prime Healthcare is an award-winning health system operating 45 hospitals in 14 states. It is one of the nation's leading healthcare service providers with nearly 45,000 employees and physicians dedicated to providing the highest quality healthcare.

Prime Healthcare has been named a "15 Top Health System" by Truven and our hospitals are consistently among the "Top 100 Hospitals" in the country. We have also been awarded the prestigious IBM Watson Health "100 Top Hospitals" award in 2018 and Prime Healthcare hospitals have earned this recognition 42 times.


The VP Health Plan Operations ? Division II is responsible for the development and administration of Prime Healthcare's health plan's operational departments, programs and services, in alignment with Prime Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations.


  • Works with staff and senior management to develop and implement provider and member service strategies to improve access and satisfaction with the Plan.
  • Serves as liaison for PHI Operations, including: Claims, Configuration Information Management, Provider Data Management, Enrollment, and Contact Center Operations.
  • Develops and executes effective member retention strategies to achieve desiredretention goals. Also serves as a key partner with community outreach to achieve profitable growth.

Ensures compliance with goals and objectives established by the Hospital Corporation and Prime healthcare system. Must be able to travel in and out of state. This position reports to the Corporate President of Operations.



1. Minimum of 10 years prior work experience in commercial insurance, Medicaid and Medicare; provider network management/development and/or management in a managed care or hospital setting is required. 

2. 5+ years of High level management experience in health plan operations 

3. Analytical skills with emphasis on plan development, assessment and negotiation, financial analysis problem solving and project/time management 

4. Requires a Masters degree in related business/health/management field or relevant Bachelors degree 

5. Direct prior job experience in Health Plan Operations for a large Hospital/Health System is a must.