Vice President of Medical Management - Managed Care (VP) - Florida

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)
  
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.
 
Primary Responsibilities:

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

Required Qualifications:

Registered Nurse (RN) degree with minimum of 10 years’ experience in practice; Active and unrestricted license to practice in any US state with the ability to obtain a Texas license within 90 days of starting employment
Master’s degree in Healthcare or Business Administration  (10 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a Master’s degree)
10+ years of management-level experience in managed care, medical management programs required
Knowledge of federal and state laws and NCQA regulations relating to managed care, and all aspects of Medical Management
Proven capability working with people at multiple levels organization, prefer multiple locations, multi-function
Excellent training and collaboration skills; excellent verbal, written communication, presentation, and facilitation skills; presentation SME with market level interface
Knowledge of fiscal management and human resource management techniques; proven evaluative and analytical skills; ability to analyze data/reports and make recommendations
Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public
Ability and willingness to travel both locally and non-locally as determined by business need
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 280,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
 
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
 
 
Job Keywords: registered nurse, healthcare, business administration, medical management, Tampa, FL, Florida