AVP, Healthcare Services

Position Overview

Provides strategy and leadership to a multidisciplinary team of healthcare services professionals in functions including utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS) and other clinical programs. Leads a team responsible for assessing, facilitating, planning and coordinating integrated delivery of care across the continuum while partnering with the executive leadership team to drive cohesive direction towards company goals and quality, cost-effective member care.

Key Responsibilities

• Provides health plan or enterprise strategy development, vision and direction for one or more key healthcare services functions (care management, care transitions, utilization management, behavioral health and/or nurse advice line); demonstrates accountability for performance and financial results, determines clinical, quality, and financial measures for success, and designs standardized protocols with timely implementation.
• Ensures adequate training from knowledgeable staff and coordinates with other departments as needed while focusing on continual refinement of operational processes.
• Develops and promotes interdepartmental integration and collaboration to enhance clinical services; manages and evaluates team performance; and coordinates with leadership to ensure adequate staffing, service levels, and customer satisfaction through monitoring staff productivity and performance indicators.
• Ensures monthly auditing is performed with appropriate follow-up.
• Engages in clinical training activities and outcomes while developing and mentoring healthcare services leaders.

Required Qualifications

• At least 10 years of healthcare experience with a minimum of 7 years in managed care in areas such as utilization management, care management, care transitions, behavioral health, LTSS, or an equivalent combination of education and experience.
• At least 5 years of healthcare management/leadership experience.
• Current licensure as a Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification is required only if mandated by state contract, regulation, or licensing board, and must be active and unrestricted.
• Experience working within applicable state, federal, and third party regulations.
• Ability to manage conflict and lead through change.
• Operational and process improvement experience.
• Ability to collaborate across a highly matrixed organization.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving, and critical-thinking skills.
• Strong written and verbal communication skills.
• Proficiency with Microsoft Office suite or applicable software programs.

Preferred Qualifications

• Registered Nurse (RN) with an active and unrestricted license in the state of practice.
• Certification as a Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or another relevant healthcare/management certification.
• Medicaid/Medicare population experience.
• Clinical experience.

Benefits & Perks

• Compensation: Pay Range: $122,430.44 - $238,739.35 per ANNUAL (Actual compensation may vary based on geographic location, work experience, education and/or skill level).
• Benefits: Competitive benefits package.
• Employment Type: Full Time.