SVP, Care Management

Job Summary:

Senior Vice President, Care Management is responsible for providing leadership and oversight for all aspects of care management programs including market and enterprise

Essential Functions:

• Responsible for the planning and execution of clinical programs including overseeing operational care management and Utilization Management for fully integrated programs.
• Direct and oversee the development, implementation, integration and maintenance of care management and processes with all market clinical leadership teams and corporate partners
• Develop, operationalize and oversee all standardization and clinical content to scale to growth and continued process improvements within all Clinical teams
• Responsible for direct leadership over all enterprise senior Market care management leadership and downstream care management teams
• Build and maintain relationships with key stakeholders across the organization
• Provide strategic oversight and support for the development and management of RFP processes/responses, etc.
• Lead and support M&A initiatives, ensuring alignment with organizational objectives and successful execution
• Ensure comprehensive budget oversight, including analysis of financial data, identification of variances, and strategic adjustments to optimize financial performance.
• Ensure the communication, implementation and maintenance of clinical deliverables are fully implemented, standardized, and monitored routinely
• Collaborate with the organization’s member care leaders in other key operational areas to ensure successful integration of innovation and technology are achieved to fully support clinical needs
• Provide leadership and direction to leaders to ensure tasks, goals and strategies are successfully achieved
• Function as a liaison/consultant related to clinical operations/ programs with regulators, market/executive level leaders, and corporate partners
• Execute on population health strategy to support utilization management, quality, and provider and member experience.
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in business, healthcare or related field or equivalent years of relevant work experience is required
• Master’s degree is preferred
• Minimum of ten (10) years of clinical operations leadership experience is required
• Minimum of five (5) years of senior level management experience is required
• Minimum of 5 years Managed Care experience in a multi-market organization

Competencies, Knowledge and Skills:

• Considerable knowledge of business theory, business processes, management, budgeting, and business office operations
• Thorough understanding of care management, utilization management programs and operational compliance, governance principles, analytics, and business intelligence
• Excellent understanding of vision and operationalization of clinical program implementation and oversight in a multi-market delivery
• Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint
• Excellent written and verbal communication skills
• Ability to develop, prioritize and accomplish goals
• Ability to work independently and within a team environment
• Effective listening and critical thinking skills
• Strong interpersonal skills and high level of professionalism
• Effective problem-solving skills with attention to detail
• Training/teaching skills
• Population health, disease management and wellness program knowledge

Licensure and Certification:

• Case Management Certification and/or licensure in an appropriate clinical area / MCG Certification
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time