VP of Health Care Management
The VP of Health Care Management is responsible for the development, implementation and oversight of the integrated Medical Management Programs. These initiatives will include the establishment of indicators for monitoring and evaluating quality care, appropriateness, continuous improvement, member satisfaction, utilization, and case management across the continuum of care to members. Provides education in the area of healthcare management. Maintains liaison with state regulatory agencies. Participates in accreditation of plan with the National Committee of Quality assurance. Develop professional relationships with community agencies.
1.Directs and provides leadership for designing, developing, and implementing the local plan integrated medical management program to meet the demographic and epidemiological needs of the population serviced.
2.Directs Healthcare Management Program for membership including pediatrics, obstetrics, NICU, Behavioral Health and other services.
3.Establishes objectives and annual goals in conjunction with the Medical Director to meet objectives established by the Plan CEO/COO and corporate HCMS.
4.Directs daily activities for utilization management staff.
5.Promotes plan-wide understanding, communication, and coordination of Integrated Medical Management Programs.
6.Works with provider relations, QI and Health Promotions to develop and implement effective provider communications, quality assurance and member outreach programs.
7.Oversees the provision of case management services for cases involving complex, chronic, or catastrophic illness or injury.
8.Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.
9.Analyzes validity of quality/healthcare management data/reports.
10.Coordinates on a quarterly basis reporting of quality initiatives to all appropriate plan committees.
11.Supports ensure compliance with National Committee for Quality Assurance (NCQA).
12.Assures compliance with state and Federal utilization requirements.
13.Monitors and makes recommendations for oversight of utilization management delegated services.
14.Participates in Disease Management Program initiatives.
15.Assists in developing the annual operating and capital budgets to sufficiently meet departmental needs.
16.Ensures that department stays within budget and accounts for variances.
17.Interviews, manages, evaluates, and develops departmental staff.
18.Works collaboratively with key health care professionals toward identification of opportunities for improvement, trend analysis, education and development of appropriate action plans for problems resolution.
19.Develops presentations on Integrated Medical Management activities for a variety of audiences.
20.Other duties as requested or assigned.
Required: Bachelor’s Degree required;
Preferred: MSN, MSW, MPH or MPA preferred.
Years and Type of Experience
Specific Technical Skills
Certifications or Licensure