• Vice President, Health Services

    Job Locations US-VA-Glen Allen
    Job ID
    2018-4996
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The Vice President, Health Services provides oversight and management of integrated health services within the medical management department which encompasses Population Health Management, Utilization Management, Case Management, and Disease Management for all Virginia Premier regions and lines of business.  Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies set by the Medical Management Department to meet healthcare cost and quality targets.  This position interprets key performance metrics to develop plans, mobilize the work force, and achieve the organization's medical management outcomes relative to the Quadruple Aim (improved population health, improved experience of care for patients and providers, and lower healthcare costs) Work with the Health Services team to develop and implement effective and efficient standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operations functions and promote quality, cost-effective health care for Virginia Premier members.  Responsible for effective working relationships with regulatory/community agencies, provider communities, hospitals, and departments within Virginia Premier to improve operations, member outcomes and health plan expansion through growth opportunities. Serves as part of the executive leadership team and has shared accountability for an integrated approach to meeting overall department and company goals.

    Responsibilities

    • Responsible for oversight of management of Utilization Management (UM) and Care Management, Disease Management, and Clinical Program development for all lines of business. 
    • Development and implementation of a plan for on-going monitoring and enhancement of procedures and policies by providing operational expertise and support to all areas of the organization creating value through reducing expense, generating revenue and improving outcomes
    • Identify and lead new business opportunities by reviewing and analyzing local, state and federal standards to develop and maintain innovative programs for the expansion of the health plan
    • Perform forecasting and strategic planning for Medical Management and Virginia Premier operations by identifying operational strengths and deficiencies and impacts to the operations of the company
    • Design, develop and implement regulatory administrative programs and service strategies with an emphasis on refining operations, enhancing profitability and improving member outcomes
    • Attend board meetings and communicate departmental outcomes and strategy to ensure they are kept fully informed on the condition of the organization and influencing factors
    • Review specialized reports to improve the Health Services’ process and present to Medical Management Committees and Virginia Premier Operations
    • Develop departmental and company goals that enhance the functionality of the department and company and resolve business issues through solution-oriented projects
    • Day- to -day oversight and management of Health Services (Clinical Operations) teams including Utilization Management (prior-authorization, concurrent review, case management, care transition.) Health integration (care coordination, long term care, behavioral health, Population Management (Disease Management) and Wellness activities. Works with the Health Services management team to achieve the successful implementation of Virginia Premier clinical strategy and direction
    • Establish performance goals for clinical staff and ensure continuous feedback regularly, throughout the year. Manage attrition effectively.
    • Day-to-day oversight and management of operations of the department to include system support, logistics, reporting (internal and regulatory), staffing and program development
    • Mentors, guides and develops skills of senior management team members in a consistent and effective manner
    • Develop initiatives to achieve budgeted reductions in medical expenses and work collaboratively with the quality department to increase quality scores
    • Manage implementation of analytical studies that clearly quantify the benefits of Health Services programs to ensure that resources are appropriately allocated to programs; that operational controls exist and efficiencies are maximized. Abandon initiatives and programs that do not produce significant quantifiable results and concentrate on driving those that do
    • Focus on continual refinement of operational processes within the clinical operations teams. Champion review of team processes, workflows and activities to improve the efficiency of the clinical operations teams to meet cost and quality goals
    • Assume responsibility for ensuring effective inter-departmental collaboration and interaction between the Health Services staff and other departments.
    • Collaborate with internal and external stakeholders to provide quality healthcare services to VPHP members responsible for ensuring staff orientation and supervision
    • Develop and monitor detailed training program for departmental operational expansion and product development
    • Maximize use of resources, ensure cost containment, and responsible fiscal management
    • Participate in recruitment and retention of new providers and others as needed
    • Participation with community, regional, state and national organizations to facilitate population based program development
    • Ensure department exercises safe work practices
    • Maintain an updated knowledge and application of NCQA, DMAS, CMS and other relevant policy and regulatory organizations’ standards
    • Responsible for ensuring health service’s compliance with NCQA standards and overall regulatory compliance while maintaining NCQA accreditation and the Virginia Department of Health Quality Assurance Certification
    • Supervise reporting activities to clinical review organizations and regulatory agencies

    Qualifications

    MINIMAL FORMAL EDUCATION REQUIRED

    • Registered nurse licensed in Virginia
    • Master’s degree in business or healthcare field

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Ability to utilize various computer software programs and possess a working knowledge of coding
    • Proven leadership skills and ability to adapt to rapidly changing technology and apply to business need
    • Ability to organize, prioritize tasks and develop systems to meet objectives of the department, company and business associates
    • Strong organizational, analytical and interpersonal skills
    • Managed care experience required

    WORK BACKGROUND/EXPERIENCE REQUIRED

    • Five or more years of experience in managed care medical management and knowledgeable of systems, applicable state, federal and third party regulations
    • Highly motivated individual with the ability to work independently
    • Must possess strong leadership capability, problem-solving, organizational skills, and the desire to foster good working rapport
    • At least 5 years of progressive management experience in the area of health services and medical management and medical expense oversight in an HMO setting.

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position.

     

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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