Vice President Medical Management

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Vice President Medical Management','MEM007188','!*!The Vice President of Medical Management is accountable for daily Medical Management Department operations. The Vice President is required to ensure the Medical Management Department attains their defined goals and objectives while maintaining consistency with the strategic, operational, and budgetary goals approved by the Board of Directors for the **MEMBERS ONLY**SIGN UP NOW***. Medical Foundation. The Vice President’s responsibilities include leadership direction for all Medical Management Department employees as well as setting the direction and scope of all activities related to Referral Management, Inpatient Case Management, Ambulatory Case Management, Disease Management, ACO, Regulatory Compliance and Quality Management.

Successfully performs a leadership role in the direction, monitoring and support of the Medical Management staff.
Continually identifies opportunities for employee and process improvements and ensures additional orientation, training and skill development is provided on an ongoing basis, either through direct involvement or delegation to the department management team.
Accountable for ensuring that all department functions are staffed appropriately via established industry benchmarks and leads and supports the Directors as needed in establishing a department culture while meeting or exceeding objectives related to staffing and performance standards.
Assumes accountability for ensuring compliance with State and Federal regulatory requirements, legislative mandates, health plan delegation requirements and accreditation standards.
Develops, implements and annually reviews the results of the Quality Improvement and Utilization Management plans and programs in partnership with department Directors.  Revises plans and programs, as needed, to ensure that all applicable governmental and regulations associated with delegated functions are met and/or exceeded.
Facilitates the Medical Management department meetings, either directly or through delegated authority, and collaborates with the CMO, Medical Directors, and Department Directors in all strategic planning. This will include establishing annual department goals and objectives by function, product development, process improvement and critical decision making.
Under the guidance of the CMO and in collaboration with the Medical Directors, develops and coordinates the successful performance of medical management processes, policies and procedures to assume that medically necessary services are delivered efficiently, at optimal cost and in an efficient manner.
In partnership with Medical Directors and Medical Management Directors, identifies areas within case management and utilization management of over or under clinical utilization through the use of data and tools provided by the Finance and Decision Support departments.  In conjunction with the CMO and Medical Management team, drives initiatives, develops and implements changes in processes or initiatives that will improve outcomes or mitigate aberrant trends.
Oversees and supports the strategic and operational processes to successfully manage the commercial and senior ACO products. This includes the development of key relationships with ACO /DTE leaders and engagement and oversight of cross departmental workstreams.
Champions a culture of open, clear communication and collaboration. Leads by example interdepartmentally, intradepartmentally and with external customers and organizations.
Develops, monitors and implements the department budget under the direction of the CMO and in cooperation with the Finance Department, Medical Directors and Clinical Directors. Approves all department expenditures per company policy and documents budget variances as required.
Encourages and mentors effective working relationships with health plan partners through active engagement and participation with the health plans. Works in conjunction with Payor Contracting to identify and develop appropriate Joint Operations Committee (JOC) agenda items.
In conjunction with the CMO, and in collaboration with the Medical Directors and Medical Management Directors, leads staff toward the development of new programs designed to enhance departmental operations and/or create alignment with corporate strategic goals.
Consistently supports compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, and adhering to applicable federal, state and local laws and regulations, accreditation and license requirements (if applicable), and current MCMF and MHS policies and procedures.
Serves as a primary liaison and channel of communication between the CMO and committees, external customers and organizations, and medical and administrative staff.
','!*!Education/Licensure:
 

Bachelor’s degree in Nursing or healthcare related field. A Master’s degree in Business Administration or health care related field preferred. 
Current California unrestricted R.N. License required. 

 
Experience:
 

Minimum of 10 years of medical management experience with IPA’s, medical groups or HMO’s. 
Experience must contain a minimum of 5-7 years specifically with an IPA or medical group. 
Prior medical management experience of multiple departments or functional areas within a managed care setting.
Must have a familiarity with Federal and State governmental care regulations and accrediting agency requirements.

 
Knowledge:
 

Strong background in strategic planning, financial analysis and contract negotiation.
Exceptional leadership skills and organizational skills as well as the proven ability to manage staff.
Excellent verbal and written communication skills, including meeting facilitation and public speaking.
Expert decision making and problem analysis skills.
Knowledge of HIPAA rules and regulations.
','United States-California-Fountain Valley','','Management, Administration','**MEMBERS ONLY**SIGN UP NOW***. Health Services','Full-time','Regular','VP/Senior Executive','','May 8, 2023','8/40 work shift hours','8/40 work shift hours','','','Day Job','8:00','8:00','5:00','5:00','**MEMBERS ONLY**SIGN UP NOW***. Health Services','**MEMBERS ONLY**SIGN UP NOW***. Health Services','Vice President Medical Management

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