Revenue cycle management [h1.location_city]

Vice President of Medical Management

The Vice President of Medical Management, reporting to the Senior Vice President, Health Care Services is responsible for leading and transforming the medical management of in-patient, ambulatory and post-acute settings. This leader analyzes market trends and dynamics to identify opportunities and is responsible for developing and executing a multi-year strategy that aligns with the company's vision and goals. This position is accountable for evaluating internal operations against standard KPI designed to improve overall access to care, lower the total cost of care, and ensure high quality in compliance with all state and regulatory requirements. This role will be responsible for fiscal and administrative oversight of a large internal team focused on industry standard productivity measures while consistently delivering high inter-relator reliability. This leader is also responsible for developing clinical platform strategy to meet the current and prospective regulatory requirements for automation and inter-operability.

Key responsibilities include :

• Provide leadership and mentoring to the medical management team, fostering a culture of innovation and continuous improvement.
• Oversee and lead the design, implementation and delivery of key strategies aimed at ensuring consistent, efficient, and impactful UM programs
• Develop comprehensive strategy to position Point32Health as a leader in utilization management and effectiveness, including pre-service, concurrent post-service reviews and transitions of care.
• Lead ROI strategic UM initiatives, including business case development, implementation and monitoring of medical and administrative cost savings strategies to support evidence-based trend management in conjunction with outcome driven KPI's
• Ensure departmental compliance with all regulatory and accreditation agency standards for state and federal requirements. Work in collaboration with IT to develop future capabilities with respect to PA automation and interoperability.
• Identify system needs, and improve internal efficiencies
• Collaborate with compliance to ensure consistent internal auditing for all regulatory processes, lead all corrective actions stemming from an audit.
• Identify key utilization trends that could impact the organization's financial and / or operational performance
• Ensure routine assessment of all metrics measured support internal and external factors that could affect performance
• Provide leadership and mentorship to the medical management team, fostering a culture of innovation and continuous improvement.
• Collaborate with stakeholders throughout the organization to identify opportunities and develop strategic partnerships
• Manage UM departmental budget, identifying ongoing opportunities to drive administrative efficiencies through automation and workflow redesign
• Other projects and duties as assigned.

Background & Experience :

Education, Certification and Licensure :

Experience (minimum years required) :

Skill Requirements :

Leadership Profile :

Establishing a Competitive and Compelling Vision

Managing an Effective and Agile Plan Execution

Creating and Cultivating Culture

Optimizing Structure and Staffing

Marshalling and Optimizing Resources

Monitoring and Appraising Results

Representing and Responding to Stakeholders

Intervening In and Managing Conflict

Investing In and Assuring Future Leadership

Senior-Level Clinical Leadership in Related Industry Experience

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we dofrom product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Salary Range : $ -

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes :

We welcome all

All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Scam Alert

Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org