AVP, Integrated Care Management Operations, Preferred Experience in Managed Care & DUALS/FIDE

This is a fully remote position, open to applicants in United States.

📋 Description

• Collaborate with Market and Corporate Leadership to enhance integrated care strategy and operations across various high-volume and/or complex population markets.

• Provide strategic direction, leadership, and oversight for integrated care initiatives throughout the continuum of care.

• Develop, standardize, scale, implement, and assess integrated care programs, operating models, processes, innovations, and evidence-based practices.

• Establish strategic, operational, and financial plans that support the effectiveness, efficiency, growth, and market needs of integrated care.

• Set performance targets, evaluate outcomes, identify trends, and execute corrective actions with cross-functional leaders.

• Analyze financial, utilization, quality, service, and operational reports to inform data-driven decisions.

• Create staffing models, resource allocation strategies, organizational structures, accountability systems, leadership development, succession planning, and performance improvement frameworks.

• Promote advancements in technology, data-driven solutions, social determinants of health initiatives, health equity, and continuous quality improvement.

• Ensure compliance with state regulations, URAC, NCQA, HEDIS, accreditation standards, and business requirements.

• Build and maintain relationships with hospitals, physicians, behavioral health providers, community organizations, government agencies, vendors, regulators, and other stakeholders.

• Oversee departmental and program budgets while managing resource stewardship, performance goals, and return on investment.

• Provide leadership and support to both direct and indirect leaders.

• Assist in new business implementations, market expansions, acquisitions, and organizational transitions.

• Advocate for the organization’s mission to enhance the health and well-being of the members and communities served.

⛳️ Requirements

• Bachelor's degree in Business, health care, or a related field is required.

• Equivalent years of relevant work experience may be considered in place of the required education.

• A minimum of 10 years of clinical operations leadership and/or experience in case management, disease management, medical management, quality improvement, or similar fields is required.

• At least 5 years of senior-level management experience is required.

• A minimum of 5 years of Managed Care experience within a multi-market organization is required.

• Experience in a collaborative matrix environment is preferred.

• Proficiency in Microsoft Office is essential.

• Skills in clinical data analysis and trending are required.

• Knowledge of healthcare, managed care, Medicaid/Medicare, long-term care, case/medical management, and quality improvement trends is necessary.

• Strong understanding of healthcare regulations, quality improvement methodologies, and population health management is crucial.

• Excellent analytical, problem-solving, and decision-making abilities are required.

• A commitment to the mission and values of the CareSource Family of Companies is essential.

• Strong oral, written, and interpersonal communication skills are necessary.

• Familiarity with regulatory reporting and compliance requirements is needed.

• Outstanding leadership skills are essential.

• Case Management or Managed Care certification is preferred.

• Certification in Healthcare Quality is preferred.

• Influenza vaccination is required during the designated influenza season as a condition of continued employment.

🏝️ Benefits

• Bonus tied to company and individual performance may be available.

• Comprehensive total rewards package.

• Annual Influenza vaccination requirement and support for immunization records.

• Reasonable accommodations for disabilities, medical conditions, and sincerely held religious beliefs.

• Remote work arrangement available.

• Travel is generally not required.