Senior VP of Medical Management (RN)

Location: Buffalo, NY
Date Posted: 04-18-2018
Senior VP of Medical Management (RN) - Managed Care
Buffalo, NY 
Senior VP of Medical Management Summary:
  • The Senior Vice President is responsible for providing leadership to the Utilization Management, Behavioral Health, Case Management, Quality Management, and Operations functions.
  • The SVP will be responsible for building a comprehensive care management plan and aligning the work force to the appropriate initiatives and measures. 
  • Responsibility for clinical compliance and accreditation are also responsibilities of the position.
  • The position will be instrumental in working with key partners within the delivery system to represent the company’s initiatives and/or programs. 
  • The position is also responsible for oversight of delegated clinical functions insuring that care determinations are managed and monitored appropriately.
  • The position will work collaboratively with the medical directors, engagement services, servicing and health care operations, provider networks, government products, the trend team and informatics to identify, develop, implement and monitor programs and process. 
  • The SVP will be responsible for reporting program effectiveness to the Executive Team as well the Board of Directors when appropriate.
Senior VP of Medical Management Background:
  • Valid, unrestricted state Registered Nurse (R.N.) license and Bachelor’s degree; Master’s degree in healthcare related field preferred.
  • Roughly 5 years of recent acute care clinical nursing experience.
  • 15 years of population health management, quality management, information management and/or program development experience required.
  • 7 years of progressive leadership experience in a health care environment required; managed care experience preferred.
  • Experience managing clinical teams in a case management, utilization management and/or quality management function preferred.
  • Solid understanding of the healthcare systems, operations and regulatory requirements required. 
  • Solid understanding of clinical compliance regulations with experience with regulatory bodies such as CMS, NCQA, DOH, DFS etc.
  • Prior department budgetary responsibility required.
  • Proven ability to understand utilization trends and to develop initiatives designed to bend trend while insuring appropriate access to quality care.
  • Demonstrated ability in lead and motivate clinical and administrative teams to achieve specific objectives.
480.269.9491 (CALL – TEXT – FAX)
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