Regional managed care organization.
This position will report to the Chief Operating Officer and manage five direct reports and approximately 400 team members.
The Vice President, Care Management and Population Health is a senior clinical leader in the organization. This individual will partner with other clinical leaders in the organization to support the engagement and success of care management programs, outcomes, and policies. As an executive leader, the Vice President will identify and oversee the development and execution of strategies that position the company, its leadership, and the organization for success. Specific duties will include, but not necessarily be limited to:
- Provide day to day direction to the Care Management and Specialty Population teams (Care Managers, Social Workers, Nursing, and related support staff) to meet Care Management and Population Health targets, goals, and objectives.
- Accountable for setting the goals and objectives, including working collaboratively with medical economics/analytics teams, to understand current state and defining multi-year targets for improvement.
- Develop and implement care management (CM) models for all applicable member populations.
- Design and develop programs that integrate complex care, long-term services and support, care and disease management, care transitions, care coordination, and other services that meet contractual and regulatory requirements. Responsible for focused measurement of program performance.
- Work closely with leaders of the Utilization Management team to ensure consistency across various programs focused on managing overall care delivery for members. Participate in the oversight and leadership to ensure outcomes, quality standards, and accreditation standards are met.
- Identify opportunities for process and care outcome improvements.
- Develop and manage operational budgets, establishing appropriate staffing levels consistent with targeted productivity and organizational performance targets.
- Provide support and/or leadership for key stakeholders which could include Board, Network Provider, Utilization, and Budgeting functions.
- Collaborate cross-functionally to manage the coordination and delivery of quality care and outcomes, member and provider outreach, care management strategies across the member populations, and provider network. Coordinate with technical and operational leaders throughout the enterprise to ensure capabilities and processes are in place to effectively deliver care management programs.
- Ensure that team members receive appropriate supervision and professional development. Mentor directors to implement and carry out the related training and coaching.
- Provide support to providers to whom care coordination has been delegated to ensure consistent understanding of the company’s programs and performance expectations.
- Registered Nurse or master’s level Licensed Clinical Social Worker with a current active license.
- 10+ years of progressive healthcare experience including at least five years in nursing or health related, behavioral, or public health field; experience in a managed care environment is preferred.
- Minimum of five years’ experience managing a team.
- Strong understanding of the needs of specialty/complex populations (i.e. SMI, SUD, I/DD, foster care), such as those in MA Duals, Medicaid ABD, LTSS programs is highly preferred.
- Demonstrated skills and experience in collaborative, strategic, and analytical thinking.
- Strong interpersonal skills and demonstrated ability to lead multiple projects simultaneously.
- Proven ability to manage large-scale projects in a fast-paced, deadline-driven, and highly collaborative environment.
- Strong understanding of healthcare, medical delivery, and medical management.
- Knowledge of social determinants of health; ability to engage patients/members who have barriers to health management and/or care.
- Displays willingness to make timely decisions; exhibits sound, accurate, and independent judgment.
- Entrepreneurial spirit with a demonstrated ability to work collaboratively and influence others.
- Effective communicator at all levels of an organization, both internal and external.
- Knowledge of healthcare analytics, metrics, and an ability to interpret data (cost of care, quality outcomes, social determinants, etc.).
Compensation will be commensurate with experience including a competitive base salary, bonus opportunity, and competitive benefits package.