Vice President Medical Management

Location

While professional experience and qualifications are key for this role, make sure to check you have the preferable soft skills before applying if required.

Fountain Valley, CA, United States

Posted on

May 08, 2023

Profile

The Vice President of Medical Management is accountable for daily Medical Management Department operations. The Vice President is required to ensure the Medical Management Department attains their defined goals and objectives while maintaining consistency with the strategic, operational, and budgetary goals approved by the Board of Directors for the Medical Foundation.

The Vice President’s responsibilities include leadership direction for all Medical Management Department employees as well as setting the direction and scope of all activities related to Referral Management, Inpatient Case Management, Ambulatory Case Management, Disease Management, ACO, Regulatory Compliance, and Quality Management.

Responsibilities include :

• Successfully performs a leadership role in the direction, monitoring, and support of the Medical Management staff.
• Identifies opportunities for employee and process improvements and ensures additional orientation, training, and skill development is provided on an ongoing basis.
• Ensures that all department functions are staffed appropriately via established industry benchmarks.
• Ensures compliance with State and Federal regulatory requirements, legislative mandates, health plan delegation requirements, and accreditation standards.
• Develops, implements, and annually reviews the results of the Quality Improvement and Utilization Management plans and programs.
• Facilitates Medical Management department meetings and collaborates with the CMO, Medical Directors, and Department Directors in strategic planning.
• Drives initiatives and develops changes in processes or initiatives that will improve outcomes.
• Oversees and supports the strategic and operational processes to manage commercial and senior ACO products.
• Champions a culture of open communication and collaboration.
• Develops, monitors, and implements the department budget under the direction of the CMO.
• Encourages and mentors effective working relationships with health plan partners.
• Leads staff toward the development of new programs designed to enhance departmental operations.
• Maintains the privacy and confidentiality of information and adheres to applicable laws and regulations.
• Serves as a primary liaison and channel of communication between the CMO and committees, external customers, and organizations.

Education / Licensure :

Bachelor’s degree in Nursing or healthcare-related field. A Master’s degree in Business Administration or health care-related field preferred.

Current California unrestricted R.N. License required.

Experience :

Minimum of 10 years of medical management experience with IPA’s, medical groups, or HMO’s. Experience must contain a minimum of 5-7 years specifically with an IPA or medical group.

Prior medical management experience of multiple departments or functional areas within a managed care setting. Familiarity with Federal and State governmental care regulations and accrediting agency requirements.

Knowledge :

Strong background in strategic planning, financial analysis, and contract negotiation. Exceptional leadership and organizational skills.

Excellent verbal and written communication skills, including meeting facilitation and public speaking. Expert decision-making and problem analysis skills.

Knowledge of HIPAA rules and regulations.

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