Associate Vice President of Care Management (107191155)
The Associate Vice President of Care Management is responsible for successfully executing all Medical Management activities for their region. This person is responsible for planning, organizing, and directing the administration of all Medical Management Programs such as Care Management (Utilization Management, Case Management, Disease Management), Advance Care Management (Palliative Care), and Quality programs. The AVP provides oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company.
The AVP maintains organizational structure and oversight of procedures, employment, training, and supervision of all Medical Management staff. Directs long-term planning and communication regarding Medical Management issues with network physicians; and acts as a resource to all internal and external customers. The Associate Vice President coordinates duties with appropriate personnel to meet operational program needs, ensures compliance with state and federal health plan requirements, Medicare guidelines, NCQA and URAC standards. The Associate Vice President implements policy and procedures to maintain corporate and service initiatives. The Vice President integrates current clinical practice guidelines for care management services. The Associate Vice President is also responsible for cultivating new leadership for the department.
Essential Job Functions:
- Directs the overall activities of staff in the department. Serves as source of expert knowledge for all activities undertaken in the department. Establishes priorities for staff, and facilitates bilateral communication between line staff and department management. Serves as contact for communication and problem resolution for issues raised by managers from other departments. Presents professional appearance and demeanor at all times
- Actively participates in Medical Management and Quality Committee. Accountable for disseminating information to the Committee regarding market activities. This involves annual evaluation of the program with recommendations for revision as indicated. Actively participates in committees such as Medical Finance, market monthly strategic meetings, and other care management related committees
- Oversees and ensures that Care Management and Quality staff adhere to all regulations, contractual agreements, and applicable NCQA/URAC and other applicable accreditation standards. In addition, ensures adherence to other UM/CM/DM delegated agreement standards and expectations for all contracted health plans. Ensures internal audits are conducted, reviews results, formulates and implements appropriate action plans to correct any areas on noncompliance. Collaborates with Training to provide in-services on compliance to better prepare the department for audits. Makes recommendations for revisions and updates in structure and procedure to the enterprise VP and MM/Quality Committee for improvements to Medical Management functions and implements any new procedures
- Encourages Medical Management staff to develop skills and knowledge for personal growth and promotion of position. Fosters leadership skills for supervisor positions to ensure most qualified staff performs management of processes. Promotes appropriateness in the utilization of staff by being flexible and assisting others when a staffing problem occurs. Identifies and helps develop future leadership candidates
- Promotes communication to customers by informing them of updates and revision in MM policies using training or orientation opportunities, newsletters, or other available resources such as forum presentations. Takes ownership of the total work process and provides constructive information to minimize problems and increase customer satisfaction.
- Performs all other related duties as assigned
The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice
Minimum Required Education, Experience & Skills:
- Bachelor’s of Science in Nursing or related degree required. (8 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
- Active and unrestricted Registered Nurse license in any US state with the ability to obtain a Texas license within 12 months of starting employment
- Ten or more years of management-level utilization management experience in managed care with health plans required, including five or more years of experience at the Director level or above
- In and/or out-of-town travel is required
- Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
Preferred Education, Experience & Skills
- Master’s degree in Nursing or Business Administration
- 15+ years of experience in a managed care and/or disease/case/utilization management with 10+ years of management level experience
- Experience in contract language, claims, UM management guidelines and accreditation guidelines required. Additionally, the Vice President must be able to perform each of the following essential duties satisfactorily. The requirements below are representative of necessary knowledge, skill and ability
- Knowledge of federal and state laws and NCQA regulations relating to managed care, disease management, utilization management, discharge planning and complex care case management
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
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 550,000+ 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)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
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: Associate Vice President, Clinical Administration, Hospitalist Program Operations, Provider Management, Austin, San Antonio or Corpus Christi, Texas, TX