Vice President Clinical Service - Boise, United States - Cambia Health

Description

This job was posted by : For more information,please see: Vice President ClinicalService - Utilization Management & Appeals
Oregon, Washington, Idaho, Utah
Primary Job Purpose

The Vice President Clinical Services is a member of the Health ServicesOrganization (HSO) leadership team focused on enabling members toachieve their best health by simplifying their care journey, improvingquality, supporting providers in their delivery of care, and managingtotal cost.

The VP of Clinical Services is accountable for clinicalfunctions which may include care management, transition of careservices, medical policy development and implementation, utilizationmanagement, facility stay reviews and appeals.

This role helps shape and drive strategy and execution in support ofintegrated business solutions aligned to the needs of each health planline of business (e.g. Medicare, individual, ASO, etc.).

The positionoversees internal programs and external vendors and plays a key role inmedical cost stewardship and ensuring clinical quality of services tomembers.

General Functions and Outcomes
Provides leadership in developing, implementing, and communicatingshort and long-range plans, goals and objectives for the function.
Aligns team goals with the organization\'s vision and strategy.
Develops strategies and tactics to effectively manage healthcarecosts and improve clinical quality across all product lines.

Partners with leaders and stakeholders across the enterprise toprioritize activity and solutions in support of medical managementstrategies and operational plans.

Develops, recommends, and implements clinical and operationalpolicies and procedures.

Develops and manages performance against business, financial,utilization, and operational metrics to ensure results are achievedacross clinical services functions and various Lines of Business.

Analyzes and uses information and data to guide the development andimplementation of new or enhanced health care interventions thatimprove value to the member and payers.

Ensures programs meet federal and state regulations, accreditationstandards, quality metrics, client requirements and evolving modelsof care (e.g. accountable care organizations, patient centeredhomes).
Determines appropriate staffing levels and resource needs, createsand manages department and/or project budgets, allocates resourcesand approves expenditures.
Fosters an effective work environment and ensures employees receiveappropriate communication, recognition, and professionaldevelopment.
Participates in organizational talent management and successionplanning.

Expertise related to health insurance industry trends, evolvingaccountable care and payment models, case and utilization managementprograms and how to best partner with providers to achieve desiredoutcomes.

Strong communication and facilitation skills with all levels of theorganization, including the ability to resolve issues and buildconsensus among groups of diverse internal/external stakeholders.

Strong leadership, negotiation and relationship building skills.
Deep business acumen including understanding of market dynamics,financial/budget management, data analysis and decision making.
Demonstrated competency related to creating and executing businessstrategies and driving results within a large, complex organizationand/or with external partners.
Proven ability to implement and execute successful businesstransformation and lead through change.
Proven ability to develop a high performing team and manage anddevelop leaders.
The Vice President Clinical Services would have a bachelor\'s degree inusiness management, health administration or a related field, 10 yearsof management/leadership experience and five years of experience as adirector for a health plan with responsibility for medical cost andquality management, with experience in delivering health care insuranceprograms or an equivalent combination of education and experience
FTEs Supervised
4-6 direct reports and oversees a staff \> 200.
Duties are performed primarily in an office environment.
Travel to other TRG affiliate plans and to regional offices may berequired.

The expected hiring range for a Vice President Clinical Service -Utilization Management & Appeals is \$283,100-382,950 depending onskills, experience, education, and training; relevant licensure /certifications; performance history; and work location.

The bonus targetfor this position is 30% . The current full salary range for this roleis \$266,000-433,000.

Base pay is just part of the compensation package at Cambia that issupplemented with an exceptional 401(k) match, bonus opportunity andother benefits.

In keeping with our Cause and vision, we offercomprehensive well-being programs and benefits, which we periodicallyupdate to stay current.


Some highlights:
medical, dental, and vision coverage for e

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