AVP - Medicaid Healthcare Management

Position Purpose

The AVP, Medicaid Healthcare Management provides leadership, direction, and oversight (clinical operations) in the establishment of strategic direction for physical and behavioral health Utilization Management (prior authorization, inpatient review), Case Management, and Population Health. In this role, you will collaborate with internal and external partners in the development of various programs and strategies in support of current and emerging Medicaid business needs.

Description

Location: This position is full-time (40-hours/week) Monday-Friday ON-SITE at our 4101 Percival Road, Columbia, SC location.

Sponsorship: This position is not eligible for sponsorship now or in the future.

To Qualify For This Position, You'll Need The Following Required Education

• Master’s Degree or equivalent combination of education and work experience
• 10+ years of managed care experience with at least 5 years in direct Medicaid Managed Care
• Experience working within applicable state, federal and third-party regulations
• Experience meeting Quality Accreditation Standards (NCQA/HEDIS/STARS)

Required Work Experience

• Active, unrestrictive SC Registered Nursing (RN) license, Advanced Practice Registered Nursing (APRN) license or Physician Assistant (PA) license in good standing

Required Skills and Abilities

• Working knowledge of word processing software
• Knowledge of quality improvement processes and demonstrated ability with these activities
• Knowledge of contract language and application
• Ability to work independently, prioritize effectively, and make sound decisions
• Good judgment skills
• Demonstrated customer service, organizational, and presentation skills
• Demonstrated proficiency in spelling, punctuation, and grammar skills
• Demonstrated oral and written communication skills
• Ability to persuade, negotiate, or influence others
• Analytical or critical thinking skills
• Ability to handle confidential or sensitive information with discretion

Required License and Certificates

• Active, unrestrictive SC Registered Nursing (RN) license, Advanced Practice Registered Nursing (APRN) license or Physician Assistant (PA) license in good standing
• Utilization Management Certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other healthcare or management certifications

Software and Tools

• Microsoft Office 365

Work Environment

Typical office environment. Must reside in South Carolina.

What We Can Do For You

• We offer our employees great benefits and rewards.
• We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.