Vice President of Medical Management - Managed Care (VP) - Florida(Job Number:690080)
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The Vice President of Medical Management - Managed Care (VP) is a member of the executive management team. This position has responsibilities for Care Management programs for WellMed Medical Management across multiple geographies. In addition, the role will drive Operational accountability initiatives for Medical Management. As part of the role, incumbent may participate in national clinical program initiatives within OptumCare.
The position provides strategic direction, leadership and oversight for Florida Medical Management programs including: Utilization Management (UM), Disease Management (DM), and Complex Case Management (CM). Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff. The VP is responsible for coordinating with appropriate personnel to meet operational program needs, ensures compliance with state/federal health plan requirements, Medicare guidelines, NCQA and health plan requirements. Provides long-term planning and oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company.
The VP of Medical Management - Managed Care works closely with WellMed Executive Leadership and the regional Care Management leadership as well as the Regional Dyads to achieve the goals and objectives of the Care Management Program.
- Directs the development, planning and execution of continual process improvement efforts, policies, procedures, and regulatory compliance functions related to care management activities
- Provides vision and leadership to advance the care management program under WellMed to the next level of service
- Collaborates with physician leadership to execute the implementation of the care management programs as defined by WellMed. Provides information/data to market leadership as requested
- Promotes understanding, communication and coordination of all care management programs components
- Provides oversight for all activities related to delegated and regulatory requirements including: annual health plan delegation audits
- Drives adoption of best practices and trends for UM, CM, DM activities
- Participates in CMS audits of health plans and their delegates
- Monitors/analyzes metrics/data/trends, and ensures areas needing attention are communicated to applicable stakeholders
- Drives UM performance to meet targets for admissions, readmission and total health care costs for Florida
- Assists with the development of the UM Work Plan, Evaluation and the monitoring of the Work Plan activities as they related to clinical performance improvement
- Develops operating budget as necessary and participates on various teams, committees and meetings at WellMed
- Drives and assists in the design of strategic plans and management of Florida, large-scale clinical initiatives, pilots, and projects promoting quality care for seniors
- Directs and oversees innovation initiatives, data analysis activities, and evaluation strategies for clinical programs including, but not limited to, pilot projects, grant-funded research projects
Job Med & Clin Ops-General Mgmt
Primary Location US-FL-Tampa
Organization WellMed Medical Mgmt, Inc
Number of Openings 1