VP Clinical Program Management - Chicago - Full-time / Part-time

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

This branch of our local care delivery unit specializes in working with leading physicians and hospitals to successfully manage the delivery of medical services. We have developed sophisticated techniques for managing the revenue and health care expenses of medical groups. We pride ourselves at managing risk business and continue to grow our business in multiple areas serving about 90,000 managed care lives with positive results.

The Vice President, Clinical Program Management will drive the development, implementation and evaluation of all clinical-based programs delivered at the market and regional level. They will develop national standards and evaluate the effectiveness and efficient implementation of clinical programs to maximize overall impact on avoidable medical cost, utilization, outcomes, RAF, quality, STAR, disease and care management and provider/patient satisfaction. The VP will serve as part of the executive leadership team for all NAMM/Aveta markets and will demonstrate a keen understanding of how medical management interfaces with all other organization functions as well as a full understanding of all of the functions of the organization.

This individual will serve as the key clinical liaison with payer partners in each market and will ensure that all payer policies and procedures related to medical management and compliance are properly integrated with internal policies and rolled out to all constituents. Further, they will be responsible for negotiating standard practices between and among the organization and payers. Payer partners include organizations such as United, Humana, Aetna, Centene, Molina, Cigna and locally-owned health plans.

This role must ensure that clinical programs are in compliance with all State and Federal regulatory and licensing requirements and have appropriate policies and procedures in place to support all ongoing programs. This VP will collaborate with internal and external stakeholders to provide balanced support and services to the LCD clinical teams that facilitate effective implementation and monitoring. The VP, Clinical Program Management will also be responsible for clinical management of LCD expansion throughout the Midwest. Other specific responsibilities will include the following:

•  Function as a lead in the design, direction, monitoring, implementation and support of the Clinical Programs delivered under collaboration with the clinical teams


• Identify opportunities for improvement in program designs and provides additional orientation, training and skill development on an ongoing basis


• Critical leader in the completion of the transformation of NAMM/Aveta's core business from strictly commercial products to Medicare and Medicaid risk-based products


• Lead the development process for the regional structure, collaborating with leadership


• Under the direction of the market Medical Directors and in collaboration with the health care providers, develop and coordinate the implementation of new clinical programs that serve the needs of the local care delivery population


• In collaboration with provider relations and RAF teams, develops and maintains clinical programs within agreed budgets and validates ongoing programs effectiveness


• Maintain regularly scheduled meetings with the Clinical Program leads to understand operational barriers and program impact


• Participate in the Medical Management team meetings and collaborate with the market Medical Directors and Clinical Program leads in strategic planning, including establishing annual departmental goals and objectives by function, product development, process improvement initiatives and critical decision making


• Promote culture of open, clear communication and collaboration with internal & external stakeholders to identify and make recommendations for improvements to processes and systems


• With market Medical Directors and clinical staff, assess and implement process and system improvements to achieve greater efficiencies and resolve operational issues


• Prepare monthly and quarterly reports for submission to the regional leadership teams and provider committees regarding the performance of programs

• 4 year degree required, Master's degree preferred (nursing, health care administration or related field preferred)


• Active RN state of IL required


• 8+ years developing clinical program design and/or implementation


• 5+ years working with clinical programs related to direct patient care


• 5 or more years clinical leadership experience including direct management of staff in a matrix environment/relationship and successfully achieving results


• 5 or more years managing mid to large scale clinical projects /programs ($1M+)


• 3 or more years delivering presentations to key groups and senior leadership


• Previous experience in managed care organizations preferred


• Strong understanding of Medicare Advantage, Medicaid, and Commercial Plan populations required


• Strong understanding of statistical analysis, clinical study methodologies, and outcome-based measurement required


• Thorough working knowledge of HMO, IPA and managed care business concepts and principles required


• Proficient in Excel, Word, PowerPoint


• Exposure to/knowledge of national level program integration desirable


• Knowledge of Six Sigma, lean methodology highly preferred


• CPHQ, CCM, or CPUR certification desired

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM