VP of Clinical Services
Job Title: VP of Clinical Support Services
Position Description: The VP of Clinical Services will lead the Clinical Services Division consisting of a variety of clinical and support functions such as Care Management, Utilization Management, Disease Management, and Behavioral Health as well as Clinical Intake, Correspondence and Appeals. You will participate as a member of the Health Plan Leadership Team to drive integrated clinical and business strategies. Additionally, you will be responsible for delivering competitive programs that resonate in the market place and meet performance goals and commitments. This position plays a key role in medical cost stewardship and ensuring clinical quality of services to members.
Responsibilities & Requirements
· Expertise related to health insurance industry trends, evolving accountable care and payment models, case and utilization management programs, and how to best partner with providers to achieve desired outcomes.
· Strong communication and facilitation skills with all levels of the organization, including the ability to resolve issues and build consensus among groups of diverse internal/external stakeholders.
· Strong leadership, negotiation, and relationship building skills.
· Deep business acumen including understanding of market dynamics, financial/budget management, data analysis and decision-making.
· Demonstrated competency related to creating and executing business strategies and driving results within a large, complex organization and/or with external partners.
· Proven ability to implement and execute successful business transformation and lead through change.
· Proven ability to develop a high performing team and manage and develop leaders.
· VP Clinical Services would have a Bachelor’s degree in business management, health administration or related field, 10 years of management/leadership experience and five years’ experience as a director for a health plan with responsibility for medical cost and quality management, with experience in delivering health care insurance programs or equivalent combination of education and experience.
· Provides leadership in developing, implementing, and communicating short and long-range plans, goals, and objectives for the function. Aligns team goals with the organization’s vision and strategy.
· Develops strategies and tactics to effectively manage healthcare costs and improve clinical quality across all product lines. Partners with medical directors and other leaders and stakeholders to develop and implement overall medical management strategies and operational plans.
· Develops, recommends and implements clinical and operational policies and procedures. Manages the organization to provide clear metrics and ensure results are achieved across clinical services functions and various Lines of Business (e.g. commercial group and individual, government programs Medicare and Federal Employee Program).
· Analyzes and uses information and data to guide the development and implementation of health care interventions that improve value to the member and payers.
· Ensures programs meet federal and state regulations, accreditation standards, quality metrics, client requirements, and evolving models of care (e.g. accountable care organizations, patient centered homes).
· Determines appropriate staffing levels and resource needs, creates and manages department and/or project budgets, allocates resources, and approves expenditures.
· This position will lead 5-10 direct reports and a staff over 300.
· Master’s Degree required: Masters of Science in Nursing, Masters of Hospital Administration, Bachelor’s Degree required: Bachelors of Science in Nursing
· Willingness to travel 80% (Monday – Friday)
· Current Permanent U.S. work authorization required
· A minimum of 15 years’ experience in Case Management strategy for the healthcare industry required
· Case Management Certification (CCM)
It is Clear Link Partners policy to provide equal employment opportunity to all employees and applicants for employment without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit based factor in accordance with all applicable laws, directives and regulations of federal, state and city entities.