VP Healthcare Mgmt Svcs
Job ID 2013-22187 # Positions 1
Location US-VA-Virginia Beach
Search Category Health Care Administration
Type Regular Full-Time (30+ hours) Posted Date 3/6/2013
Additional Locations ..
More information about this job:
Summary:
The incumbent will serve as the primary clinical leader for Amerigroup’s dual initiative, and will be responsible for the program development, implementation, and management of Utilization Management, Case Management, Disease Management, Audit, Quality Management, Pharmacy Services, Mental Health, and/or Appeals and Grievances. The ideal candidate incumbent has at least 12 years of leadership experience in Medicaid/Medicare medical management (Nursing or Social Work), with Long Term Support Services (LTSS) and medical Geriatric experience, working in a matrix organization.
Responsibilities:
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 disease management, case management, and utilization management.
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. Promotes understanding, communication, and coordination of Integrated Medical Management Programs across the health plan.
5. Works with Provider Relations, Quality Management and Health Promotions to develop and implement effective provider communications, quality assurance and member outreach programs.
6. Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.
7. Coordinates on a quarterly basis reporting of quality initiatives to all appropriate plan committees.
8. Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state/and or federal program requirements.
9. Monitors and makes recommendations for oversight of appropriate delegated services.
10. Develops the annual operating and capital budget: ensures that departments stay within budget and accounts for variances.
11. 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.
12. Other duties as requested or assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Bachelors Degree in a health care field or equivalent experience (equivalent experience equates to 6 years related experience in addition to the required 12 years experience).
Preferred:
- Masters Degree in a health care field, or
- MBA with Health Care concentration.
Years and Type of Experience Required:
Required:
- Minimum of 12 years relevant clinical work experience and at least 7 years of leadership/management experience preferably in a managed care setting , with at least 5 years of clinical experience (post Masters for Behavioral Health).
- Previous experience with NCQA accreditation and HEDIS reporting.
Certifications or Licensures
Required:
- RN, LCSW, LPC
Language Skills
Required:
- English
Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.
SCOPE INFORMATION
# Direct Reports: 5-30
# Indirect Reports: varies
Budgetary $ Responsibility: As assigned
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
ermHO
Job ID 2013-22187 # Positions 1
Location US-VA-Virginia Beach
Search Category Health Care Administration
Type Regular Full-Time (30+ hours) Posted Date 3/6/2013
Additional Locations ..
More information about this job:
Summary:
The incumbent will serve as the primary clinical leader for Amerigroup’s dual initiative, and will be responsible for the program development, implementation, and management of Utilization Management, Case Management, Disease Management, Audit, Quality Management, Pharmacy Services, Mental Health, and/or Appeals and Grievances. The ideal candidate incumbent has at least 12 years of leadership experience in Medicaid/Medicare medical management (Nursing or Social Work), with Long Term Support Services (LTSS) and medical Geriatric experience, working in a matrix organization.
Responsibilities:
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 disease management, case management, and utilization management.
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. Promotes understanding, communication, and coordination of Integrated Medical Management Programs across the health plan.
5. Works with Provider Relations, Quality Management and Health Promotions to develop and implement effective provider communications, quality assurance and member outreach programs.
6. Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.
7. Coordinates on a quarterly basis reporting of quality initiatives to all appropriate plan committees.
8. Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state/and or federal program requirements.
9. Monitors and makes recommendations for oversight of appropriate delegated services.
10. Develops the annual operating and capital budget: ensures that departments stay within budget and accounts for variances.
11. 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.
12. Other duties as requested or assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Bachelors Degree in a health care field or equivalent experience (equivalent experience equates to 6 years related experience in addition to the required 12 years experience).
Preferred:
- Masters Degree in a health care field, or
- MBA with Health Care concentration.
Years and Type of Experience Required:
Required:
- Minimum of 12 years relevant clinical work experience and at least 7 years of leadership/management experience preferably in a managed care setting , with at least 5 years of clinical experience (post Masters for Behavioral Health).
- Previous experience with NCQA accreditation and HEDIS reporting.
Certifications or Licensures
Required:
- RN, LCSW, LPC
Language Skills
Required:
- English
Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.
SCOPE INFORMATION
# Direct Reports: 5-30
# Indirect Reports: varies
Budgetary $ Responsibility: As assigned
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
ermHO