The VP, Care Management is responsible for providing the strategic guidance, direction and overall management of the Care Management function and processes across Healthfirst products. This position oversees efforts to improve member outcomes – in functional capability, health services utilization, quality of life, and other important outcomes as measured by external quality measurement programs. The VP seeks to improve the member experience with healthcare services and with the care management process. He/she provides leadership to manage administrative costs for his/her areas, and uses data and metrics to drive constant process improvement.
- Sets the strategy, direction and goals for all of the Management function with an eye towards quality of service, productivity and process improvement.
- Serves as the subject matter expert (SME) for care management contributing to interpretation and guidance for new and emerging rules and regulations at both the state and federal level
- Partners with other clinical and operational leaders to drive consistency in process and member experience across Healthfirst departments.
- Uses internal and external benchmarks to drive high-quality outcomes and efficient processes.
- Actively participates in driving Quality and Population Health improvement efforts within care management teams and more broadly across the organization.
- Ensures compliance with all organizational policies, procedures and regulatory requirements on behalf of the Care Management function.
- Builds a high performing team that is organized and staffed effectively.
- Integrates the Care Management function into Utilization Management and other department workflows to support the coordination of care.
- Informs policy, product and process decisions across HF from the CM perspective.
- Additional duties as assigned
Regulatory or Compliance activities: Ensures compliance with all organizational policies, procedures and regulatory requirements on behalf of the Care Management function.
- A licensed Registered Nurse in New York or eligible
- 10 years of experience within Care Management
- 5 years of direct leadership experience
- Experience within a Matrixed organization
- Leadership experience in Care Management
- Work experience providing mid to long-term strategic and tactical direction and operational oversight
- Experience managing and developing large teams
- Experience within realty based leadership
- Progressive leadership experience in a health care environment
- Knowledge of Managed Long Term Care, Medicare, and Mainstream Medicaid health-care regulations, legislation and laws
- Exceptional problem-solving; process-oriented yet flexible
- Demonstrated ability to work independently and to manage multiple tasks and responsibilities
- Excellent communication skills with the ability to effectively communicate to a wide range of audiences
- Ability to work in a fast-paced environment and enhance team productivity
- Experience working with clinical professionals (nurses, doctors, etc.)
- Experience in managed care or the healthcare industry
- Nursing degree from an accredited program and New York State Registered Professional Nurse license.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
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