Associate Vice President Health Care Management Services Job

Job Title:
Associate Vice President Health Care Management Services
Job ID:
10441
Location: Jackson, MS

Full/Part Time:
Full-Time
Regular/Temporary:
Temporary

Grade: 22
Jackson, Mississippi

JOB SUMMARY:
The Associate Vice-President Health Care Management Services manages the utilization / care management process ensuring the delivery of essential services that effectively address the total healthcare needs of AMERIGROUP's members.

PRIMARY RESPONSIBILITIES:
1. Implements and manages health care management, utilization, cost, and quality objectives in accordance with the goals of AMERIGROUP Corporation's mission, vision and values, the needs of the health plans, federal and state regulatory requirements and NCQA standards.
2. Collaborates with the peers to ensure a seamless interface between HCMS and Medical Management.
3. Identifies opportunities to improve the customer service and quality outcomes for our members.
4. Collaborates with peers to initiate innovative health care pilots to improve the overall HCMS/medical management program.
5. Interfaces with other departments to ensure the complete integration of behavioral health and physical health.
6. Overseas the development of medical management policies, procedures, and guidelines.
7. Ensures implementation and continued compliance by providing updates on specific medical management standards to Directors and staff.
8. Assists in developing clinical management guidelines including: Conducting literature search to identify "evidenced-based" management. Identifying changes in practice which may require updating of guidelines. Developing DRAFT guidelines as directed. Identifying national providers experienced in treating patients. Coordinating physician advisory groups
9. Ensures that delegated medical management activities are contracted, reviewed and reported according to established criteria.
10. Evaluates programs quarterly.
11. Supports and participates in quality initiatives and activities including clinical indicators reporting, focus studies and HEDIS reporting.
12. Ensures compliance with state reporting on utilization management activities for accuracy.
13. May develop the annual operating and capital budgets to sufficiently meet departmental needs.
EDUCATION AND EXPERIENCE:
Education Required:
· Bachelors Degree in a health care field
Education Preferred:
· Masters Degree in a health care field
· MSN, MPH, MPA, or MSW or related or MBA with Health Care concentration

Years and Type of Experience Required: Required:
· Must have three years post Masters clinical experience.
· Must have at least five years of current experience in utilization management in a managed care setting.
· Must have 3 years of management experience.

Knowledge and Technical Skills Required:
· Industry and clinical knowledge - Possesses a comprehensive knowledge of managed care, best practices, and issues related to coordinating behavioral and physical health.
· Leadership - Sets a clear direction for health care. Balances marketplace requirements with the objectives of the Amerigroup health program. Able to manage indirect reporting relationships.
· Management of resources - Manages human resources to optimal performance. Efficiently manages projects to a timely completion. Identifies gaps and proposes solutions. Able to develop and manage budgets.
· Communication skills - Strong verbal and written communication skills. Able to negotiate with a variety of stakeholders. Capable of networking with internal resources as well as external partners and constituents.
· Computer skills - Possesses a working knowledge of Microsoft Office and the Internet. Interested in developing higher-level computer skills.

Certifications or Licensure Preferred:
· RN
· LCSW, LPC
· Certified Case Manager

SCOPE INFORMATION
Item Measure
· # Direct Reports 2-10
· # Indirect Reports 2-20

PHYSICAL REQUIREMENTS
· Able to operate a computer
· Able to operate a telephone
· Must be able to travel on common carriers and to adhere to AMERIGROUP's travel policies.

Equal Employment Opportunity

In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

Position contingent upon award of The Mississippi Coordinated Access Network contract.

Nearest Major Market: Jackson Mississippi
Job Segments: Executive, Healthcare, Management, Manager, Medical