-
Physician in advanced training
3 weeks ago
SilverLinx Saint George, United StatesThe Havelland Clinics GmbH is seeking you at our clinic location in Rathenow for the Department of Internal Medicine and Gastroenterology as a physician in advanced training / assistant physician for internal medicine / gastroenterology (m/f/d). The Havelland Clinics Group is a n ...
-
Senior Clinical Director
2 weeks ago
Sunrise Residential Treatment Center Washington, United StatesSunrise offers an amazing atmosphere of acceptance and support in a wonderful environment Located in St. George, UT, where red rock and beauty abound, you may come alive and thrive with the visual rewards of nature. The warm climate in the area offers a chance for quick access to ...
-
Mental Health Therapist
1 week ago
Embark Behavioral Health Washington, United States$5000 SIGN ON BONUS PAID OUT OVER 6 MONTHS · Looking for work where you can make a difference? · At Sunrise you can have a career in creating JOY and HEALING Generations · Therapist, Sunrise · Work on a team that supports one another and has a passion for creating positive chang ...
-
Mental Health Therapist
3 weeks ago
Sunrise Services Washington, United StatesOverview · $5000 SIGN ON BONUS PAID OUT OVER 6 MONTHS · Looking for work where you can make a difference? · At Sunrise you can have a career in creating JOY and HEALING Generations · Therapist, Sunrise Work on a team that supports one another and has a passion for creating pos ...
-
Senior Clinical Director
3 weeks ago
Sunrise Residential Treatment Center Washington, United StatesSunrise offers an amazing atmosphere of acceptance and support in a wonderful environment Located in St. George, UT, where red rock and beauty abound, you may come alive and thrive with the visual rewards of nature. The warm climate in the area offers a chance for quick access to ...
-
Senior Clinical Director
3 weeks ago
Sunrise Services Washington, United StatesOverview: · Sunrise offers an amazing atmosphere of acceptance and support in a wonderful environment Located in St. George, UT, where red rock and beauty abound, you may come alive and thrive with the visual rewards of nature. The warm climate in the area offers a chance for qu ...
-
Senior Clinical Director
9 hours ago
Sunrise Services Washington, United StatesOverview: · Sunrise RTC is located in sunny southern Utah, with access to many local, state, and national parks. The community lends itself to outdoor recreation activities, a wide range of community activities, and University education. Sunrise has served its students, families ...
-
Territory Manager
3 weeks ago
Avidity Science Washington, United StatesWe have an exciting opportunity to join our dynamic sales team as a Biomedical Territory Manager in the West Coast region. The successful candidate will have a proven background in building and maintaining relationships with new and existing customers and is passionate about prov ...
-
Director of Health Services
3 weeks ago
MBK Real Estate Washington, United StatesDirector of Health Services page is loaded · Director of Health Services · Apply · locations · WA - Mountlake Terrace: Mountlake Terrace · time type · Full time · posted on · Posted 2 Days Ago · job requisition id · JR102312 · Director of Health Services At MBK Senior ...
-
Speech Language Pathologist
2 days ago
Amazing Care Home Health Services Washington, United StatesJob Description · Job DescriptionAmazing Care is a nationally accredited Home Health and Home Care Agency serving clients of all ages throughout Utah, including Logan, Ogden, Salt Lake City, and St. George. As both a medical and non-medical home care provider, we offer coordinate ...
-
After Sales Clerk in the Medical Industry
5 days ago
FusionWorks Toquerville, United StatesAbout Likamed GmbH: · We are an internationally successful manufacturer of high-quality clinic and practice equipment as well as innovative medical technology. · As a family-owned company based in Eppingen, our structure is characterized by medium-sized, with short decision-makin ...
-
Driver
6 days ago
City of Hope Zion, United StatesDriver · Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope's growing national system includes its Los Angeles campus, a network of clinica ...
-
Gastroenterologist
6 days ago
AMN Healthcare Saint George, United States Full timeJob Description & Requirements · Gastroenterologist · StartDate: ASAP Pay Rate: $ $ · Intermountain Health, a large not-for-profit health system, seeks a Gastroenterologist with ERCP training or experience to join an established group of three GIs. The company offers its physici ...
-
Ultrasound Tech Maternal Fetal Medicine
8 hours ago
Intermountain Healthcare Saint George, UT, United States Full timeJob Description: · The Ultrasound Technologist provides excellent customer service by performing ultrasound examinations under the direction of a physician for identification of abnormalities leading to patient diagnosis. · Job Details · Sign on Bonus: up to $ for eligible applic ...
-
Gastroenterologist
3 weeks ago
AMN Healthcare SAINT GEORGE, United StatesJob Description & Requirements · Gastroenterologist · StartDate: ASAP Pay Rate: $ $ · Intermountain Health, a large not-for-profit health system, seeks a Gastroenterologist with ERCP training or experience to join an established group of three GIs. The company offers its physici ...
-
Trauma Registrar
1 week ago
Intermountain Healthcare Saint George, United StatesJob Description: · The Non-Clinical Data Abstractor performs accurate and timely abstraction, auditing, and monitoring of data from health information records (e.g., regulatory and accreditation required registries, Intermountain approved databases supporting clinical program, cl ...
-
Prosthetist and/ or Orthotist Clinician
2 weeks ago
Hanger St George, United StatesWhy Us? · With a mantra of Empowering Human Potential, Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products, offering the most advanced O&P solutions, clinically differentiated programs and unsurpassed customer service. Hanger's Pati ...
-
Intermountain Healthcare Saint George, United States Full timeJob Description: · The Registered Nurse (RN) is a licensed professional caregiver who assumes responsibility and accountability for assessing, planning, implementation and evaluating care of patients. The staff RN utilizes the nursing process by use of technology, therapeutic int ...
-
Nurse Practitioner
2 weeks ago
Option Care Health Saint George, UT, United StatesExtraordinary Careers. Endless Possibilities. · With the nation's largest home infusion provider, there is no limit to the growth of your career. · Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With ov ...
-
Electrophysiology-FT-St. George
1 week ago
RevereHealth Saint George, United StatesAt Revere Health, we value the health of our patients above all else. As the largest independent multi-specialty physician group in Utah, our healthcare system gives patients the best in communication, quality, coordination and innovation. Founded in 1969 in Provo, Utah, Revere H ...
Vice President Clinical Service - Washington, United States - Cambia Health Solutions
Description
Vice President Clinical Service - Utilization Management & Appeals page is loadedVice President Clinical Service - Utilization Management & Appeals
Apply
locations
Renton, WA
Utah
Oregon
Washington
Idaho
time type
Full time
posted on
Posted 3 Days Ago
job requisition id
R-4815
Vice President Clinical Service - Utilization Management & Appeals
Oregon, Washington, Idaho, Utah
Primary Job Purpose
The Vice President Clinical Services is a member of the Health Services Organization (HSO) leadership team focused on enabling members to achieve their best health by simplifying their care journey, improving quality, supporting providers in their delivery of care, and managing total cost.
The VP of Clinical Services is accountable for clinical functions which may include care management, transition of care services, medical policy development and implementation, utilization management, facility stay reviews and appeals.
This role helps shape and drive strategy and execution in support of integrated business solutions aligned to the needs of each health plan line of business (e.g. Medicare, individual, ASO, etc.).The position oversees internal programs and external vendors and plays a key role in medical cost stewardship and ensuring clinical quality of services to members.
General Functions and OutcomesProvides leadership in developing, implementing, and communicating short 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 healthcare costs and improve clinical quality across all product lines.
Partners with leaders and stakeholders across the enterprise to prioritize activity and solutions in support of medical management strategies and operational plans.
Develops, recommends, and implements clinical and operational policies and procedures.Develops and manages performance against business, financial, utilization, and operational metrics to ensure results are achieved across clinical services functions and various Lines of Business.
Analyzes and uses information and data to guide the development and implementation of new or enhanced health care interventions that improve value to the member and payers.
Ensures programs meet federal and state regulations, accreditation standards, quality metrics, client requirements and evolving models of care (e.g. accountable care organizations, patient centered homes).Determines appropriate staffing levels and resource needs, creates and manages department and/or project budgets, allocates resources and approves expenditures.
Fosters an effective work environment and ensures employees receive appropriate communication, recognition, and professional development.
Participates in organizational talent management and succession planning.
Minimum Requirements
Expertise related to health insurance industry trends, evolving accountable care and payment models, case and utilization management programs and how to best partner with providers to achieve desired outcomes.
Strong communication and facilitation skills with all levels of the organization, including the ability to resolve issues and build consensus 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 business strategies and driving results within a large, complex organization and/or with external partners.
Proven ability to implement and execute successful business transformation and lead through change.Proven ability to develop a high performing team and manage and develop leaders.
The Vice President Clinical Services would have a bachelor's degree in business management, health administration or a related field, 10 years of
management/leadership
experience and five years of experience as a director for a health plan with responsibility for medical cost and quality management, with experience in delivering health care insurance programs or an equivalent combination of education and experience
FTEs Supervised
4-6 direct reports and oversees a staff > 200.
Work Environment
Duties are performed primarily in an office environment.
Travel to other TRG affiliate plans and to regional offices may be required.
The expected hiring range for a
Vice President Clinical Service - Utilization Management & Appeals
is $283,100-382,950 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 30% . The current full salary range for this role is $266,000-433,000.
Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits.
In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current.
Some highlights:
medical, dental, and vision coverage for employees and their eligible family members
annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
paid time off
varying by role and tenure in addition to 10
company holidays
up
to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance
(no vesting period)
up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
one-time furniture and equipment allowance for employees working from home
up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards
page.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace.
All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law.
A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email
.
Information about how Cambia Health Solutions collects, uses, and discloses information is available in our
Privacy Policy
. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers
site.
About Us
#J-18808-Ljbffr