VP, Integrated Care and Utilization Management

About the role

This role will involve up to 40% travel across AbsoluteCare locations. RN license preferred. Certification in Case Management (CCM), Utilization Review Accreditation Commission (URAC), or related credentials is a plus. This role is highly focused on programmatic development around coordination of care, population health, application of data in developing targeted disease and utilization management programs, with focus on quality metrics, outcomes and overall impact on utilization. This role is a key member of our unique multi-disciplinary team working in direct collaboration with other medical professionals, to help patients become healthier and lower their unnecessary medical utilization. Our program is focused on the whole care continuum including helping navigate different transitions of care.

Responsibilities

• Further develop care management program standards, practices, protocols, policies, and procedures, in accordance with applicable laws, regulatory and accreditation requirements that are consistent with current research findings, best practices, and national professional standards to achieve excellence in patient care.
• Ensure high quality and timely delivery of care coordination, incorporating NCQA standards.
• Plan and direct operations for all care management staff, including professional development across multiple states and locations, including local managers and their teams.
• Manage staff recruitment, screening, hiring, orienting, and training for the care management team.
• Provide support to ensure superior levels of customer service to our members.
• Act as a liaison between the executive team and the care delivery teams, including clinical and financial components of the organization, in this outcome-based care model.
• Collaborate with our multi-disciplinary team to further program development, evaluate and compare effectiveness of new strategies across the organization.
• Direct and coordinate internal and external agents to maintain patient safety, compliance with applicable standards, and patient rights.
• Plan and supervise administrative aspects of the department, delivery of services, disease management programs, and long-term planning to ensure adequate staffing, resources, and system support.
• Work with the data analyst team to improve reporting and monitoring member engagement and outcomes.
• Monitor and identify barriers within the organization related to successful patient and/or organizational goals.
• Provide training within the organization for other departments within the organization.
• Oversight and management of NCQA Complex Care Management program.