AVP, Healthcare Services

Healthcare Services Leader

Provides strategy and leadership to a multidisciplinary team of healthcare services professionals, in some or all of the following functions : utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), and other clinical programs. Leads team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum. Partners with executive leadership team to provide cohesive direction towards company goals. Contributes to overarching strategy to provide quality and cost-effective member care.

Provides health plan or enterprise strategy development, vision and direction for one or more of the following key health care services (HCS) functions : care management, care transitions, utilization management, behavioral health and / or nurse advice line. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.

Determines clinical, quality, and financial measures for success.

Designs standardized protocols, develops policy and ensures timely implementation with corporate and health plan input.

Ensures adequate training occurs from knowledgeable staff and coordinates with other departments as needed. Focuses on continual refinement of operational processes.

Develops, performs and promotes interdepartmental integration and collaboration to enhance clinical services.

Manages and evaluates team members in the performance of various clinical management activities.

Coordinates with leadership to ensure adequate staffing and service levels, and maintains customer satisfaction by implementing and monitoring staff productivity and performance indicators.

Ensures monthly auditing is occurring with appropriate follow-up.

Engages in clinical training activities and outcomes.

Develops and mentors healthcare services leaders.

Required Qualifications

At least 10 years experience in health care, and at least 7 years of managed care experienced in one or more of the following areas : utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.

At least 5 years health care management / leadership required.

Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and / or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.

Experience working within applicable state, federal, and third party regulations.

Ability to manage conflict and lead through change.

Operational and process improvement experience.

Ability to work cross-collaboratively across a highly matrixed organization.

Ability to prioritize and manage multiple deadlines.

Excellent organizational, problem-solving and critical-thinking skills.

Strong written and verbal communication skills.

Microsoft Office suite / applicable software program(s) proficiency.

Preferred Qualifications

Registered Nurse (RN). License must be active and unrestricted in state of practice.

Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ) or other health care or management certification.

Medicaid / Medicare population experience.

Clinical experience.