VP, Health Services

Glen Allen VA 23060 Suite 100

Job Description

Responsible for the leadership and performance of the health services function for an assigned site and/or strategic business unit (SBU) in the delivery of high quality and cost effective care and service. Serves in a results-oriented operations role and is accountable for clinical results, including all utilization, medical and health plan programs and outcomes for all product lines. Accountable for the consistent implementation and effective management of clinical policies, procedures and best practices.
  • Plans, develops and manages the Uniform Assessment System (UAS) function, partnering with Finance and the State to ensure scores and premiums are forecasted correctly to drive revenue to the plan.
  • Develops and communicates health services team objectives.
  • Establishes performance goals for health services staff and ensures continuous feedback regularly, throughout the year.  Manages attrition effectively.
  • Implements and manages cost-effective and high quality utilization, care, disease management and other clinical programs, including health plan performance reviews, corrective actions and plans.
  • Sets performance standards and implements processes to regularly and consistently measure qualitative performance.
  • Implements processes to identify developmental needs of team members and a means of addressing those needs.
  • Manages cost of care, utilization and UAS to achieve the most effective financial performance while ensuring appropriate quality of care. Manages financial performance on a unit cost and operating basis.
  • Develops and manages clinical operating budget.  Participates in strategic planning and clinical model and policy development as requested by leadership.
  • Avoids payment of performance penalties and optimizes opportunities to earn incentives.
  • Participates in underwriting process.

General Job Information

Title

VP, Health Services

Grade

32

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

3/13/2019

Date Requisition Created

3/13/2019

Minimum Qualifications

Education

Bachelors: Nursing (Required), Masters: Behavioral Health (Required)

License and Certifications - Required

LMSW - Licensed Master Social Worker - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • LCSW or RN license required.
  • 10+ years minimum experience in a management position in managed care, post-degree.
  • Experience with State and external accreditation managed care audits and reviews required.
  • Experience with writing and implementing program level policy and procedures required.
  • Track record of strong clinical utilization and care program management, general management, supervisory, team building and leadership skills.
  • Excellent writing and communication skills.
  • Direct clinical experience in multiple settings and levels of care, including both mental health and substance abuse.
  • Knowledge of relevant federal and state regulations pertaining to managed behavioral health and insurance products.
  • Proficient with computer and software programs (e.g.; Microsoft Word, Excel) and the Internet required.
  • Experience applying medical management treatment guidelines, such as InterQual / McKesson, Milliman, or other practical management guidelines required.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”