National VP, Health Services, MCC

United States

Job Description

Responsible for setting the strategic vision, clinical policy and operating plan for Magellan Complete Care (MCC), an organization whose sole mission is to support the needs of complex populations with physical, behavioral and social determinants of health challenges. Collaborates with the Chief Medical Officer and the senior leadership team to achieve overall company goals while ensuring Magellan Complete Care (MCC) delivers high quality and cost-effective clinical care and services. Oversees the clinical program and policy development for Medicaid and Medicare, utilization management, population health, clinical training and care management standardization for all populations (including long term services and supports). Accountable for consistent implementation and effective management of clinical policies, procedures and best practices.
  • Provides clinical leadership, oversight, consultation and management for MCC Clinical Programs, including case management, long term services and supports, utilization management (UM), clinical operations, audit oversight and clinical training, ensuring contractual requirements and accreditation standards are met.
  • Provides strategic direction and implementation assistance for disease management and social determinants of health programs nationally.
  • Identifies clinical trends and best practices and partners with clinical leadership and other cross functional teams to develop and adopt best practices to improve the clinical and cost effectiveness of services to members.
  • Provides clinical leadership in the design and development of evidence-based utilization, disease and care management programs.
  • Utilizes data and metrics tied to clinical and business outcomes.
  • Develops and implements innovative programs and solutions and drives standardization in processes and clinical initiatives to drive improved care and cost savings, ensuring compliance with contractual requirements and state and federal regulations.
  • Develops consistent, standardized, best practice workflows and staffing models and supports health plans with implementation, ensuring contractual requirements are met.
  • Collaborates with health plan clinical leaders to implement programs, policies and initiatives to achieve strategic goals and overall performance.
  • Provides leadership for the development of external partnerships, including with state regulators, health care leaders and professional organizations.
  • Oversees the development, delivery and implementation of Magellan Complete Care's clinical training program and team, ensuring programs meet the needs of associates and members.
  • Establishes performance goals for health services staff and ensures continues feedback regularly, throughout the year.
  • Manages attrition effectively.
  • 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.
  • Leads strategic planning and clinical model and policy development.
  • Represents MCC as clinical subject matter expert in RFP responses and business development effort.

General Job Information

Title

National VP, Health Services, MCC

Grade

32

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

6/19/2019

Date Requisition Created

6/19/2019

Work Experience

Clinical

Education

Bachelors: Nursing (Required), Masters

License and Certifications - Required

RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • 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. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

“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.”

Haita Makanji VP of Clinical Strategy and Programs at Magellan MRx