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VP, Field Health Services

Company: Wellcare Health Plans
Location: Tampa
Posted on: September 15, 2019

Job Description:

Provides the vision, strategic direction and management of the operations for the market Health Services areas which includes Utilization Management, Field and Telephonic Care Management and Quality Management. Manages the improvement of clinical and quality indicators, improving medical cost as well as improving resource utilization in accordance with corporate and market objectives.Reports to:Regional VP Clinical ManagementDept.:PHS FL Care Mgmt.Location:Tampa (Rocky Point), FLEssential Functions:Provides operational and strategic leadership for field clinical programs.Provides subject matter expertise to support operations, product development, and growth initiatives.Work collaboratively with medical directors and market leadership to deliver clinical programs that support the business objectives.Develops value propositions for clinical programs through quantitative analytics, ROI, and evidence-based data.Supports corporate Quality Improvement plan and market Quality Improvement plan to achieve target HEDIS results.Manages and develops direct reports who include directors and/or managers. Sets direction, allocates, and reallocates utilization of resources as required.Determines operational tactics to implement policies and strategies. Establishes reporting systems and controls to ensure compliance with company requirements.Provides oversight of and integration with vendors that touch on health service operations and serve market enrolleesSets overall goals, performance standards, and operational priorities for one or more functions and manages resources to operational goals and budget.Creates a motivated customer-service driven environment.Makes recommendations on matters of policy and approve changes in area of expertise.Provides leadership, oversight, direction and guidance of operations in Health Services clinical field management. Ensures that activities are carried out in a timely manner.Established market Health Services clinical management goals, strategy and objectives.Develops strategic plans with the ultimate goal to improve the health status of our members, measure outcomes, improve outcomes and subsequently reduce cost, consistent with the corporate and market goals and objectives of WellCare.Provides oversight of program analysis, which includes ongoing strategic planning of the clinical management programs.Develops and manages activities to ensure compliance with Federal, State, and NCQA accreditation standards.Oversees and participates in Performance Improvement Activities.Plans annual operating budget and monitors budget performance.Manages the development of policies and procedures, ensures implementation and adherence of same.Participates in information management and demonstrates proficiency in gathering, and accessing informationRepresents WellCare Health Services at various meetings and conferences on an ongoing basis.Recognizes and observes all company and departmental policies and procedures.Focuses on achieving departmental and organizational objectives.Provides proactive approach and support to emerging business activities established to remain competitive in the marketplacePreforms other duties as assigned Additional Responsibilities:Provides operational and strategic leadership for field clinical programs.Provides subject matter expertise to support operations, product development, and growth initiatives.Work collaboratively with medical directors and market leadership to deliver clinical programs that support the business objectives.Develops value propositions for clinical programs through quantitative analytics, ROI, and evidence-based data.Supports corporate Quality Improvement plan and market Quality Improvement plan to achieve target HEDIS results.Manages and develops direct reports who include directors and/or managers. Sets direction, allocates, and reallocates utilization of resources as required.Determines operational tactics to implement policies and strategies. Establishes reporting systems and controls to ensure compliance with company requirements.Provides oversight of and integration with vendors that touch on health service operations and serve market enrolleesSets overall goals, performance standards, and operational priorities for one or more functions and manages resources to operational goals and budget.Creates a motivated customer-service driven environment.Makes recommendations on matters of policy and approve changes in area of expertise.Provides leadership, oversight, direction and guidance of operations in Health Services clinical field management. Ensures that activities are carried out in a timely manner.Established market Health Services clinical management goals, strategy and objectives.Develops strategic plans with the ultimate goal to improve the health status of our members, measure outcomes, improve outcomes and subsequently reduce cost, consistent with the corporate and market goals and objectives of WellCare.Provides oversight of program analysis, which includes ongoing strategic planning of the clinical management programs.Develops and manages activities to ensure compliance with Federal, State, and NCQA accreditation standards.Oversees and participates in Performance Improvement Activities.Plans annual operating budget and monitors budget performance.Manages the development of policies and procedures, ensures implementation and adherence of same.Participates in information management and demonstrates proficiency in gathering, and accessing informationRepresents WellCare Health Services at various meetings and conferences on an ongoing basis.Recognizes and observes all company and departmental policies and procedures.Focuses on achieving departmental and organizational objectives.Provides proactive approach and support to emerging business activities established to remain competitive in the marketplacePreforms other duties as assigned Additional Responsibilities:Provides operational and strategic leadership for field clinical programs.Provides subject matter expertise to support operations, product development, and growth initiatives.Work collaboratively with medical directors and market leadership to deliver clinical programs that support the business objectives.Develops value propositions for clinical programs through quantitative analytics, ROI, and evidence-based data.Supports corporate Quality Improvement plan and market Quality Improvement plan to achieve target HEDIS results.Manages and develops direct reports who include directors and/or managers. Sets direction, allocates, and reallocates utilization of resources as required.Determines operational tactics to implement policies and strategies. Establishes reporting systems and controls to ensure compliance with company requirements.Provides oversight of and integration with vendors that touch on health service operations and serve market enrolleesSets overall goals, performance standards, and operational priorities for one or more functions and manages resources to operational goals and budget.Creates a motivated customer-service driven environment.Makes recommendations on matters of policy and approve changes in area of expertise.Provides leadership, oversight, direction and guidance of operations in Health Services clinical field management. Ensures that activities are carried out in a timely manner.Established market Health Services clinical management goals, strategy and objectives.Develops strategic plans with the ultimate goal to improve the health status of our members, measure outcomes, improve outcomes and subsequently reduce cost, consistent with the corporate and market goals and objectives of WellCare.Provides oversight of program analysis, which includes ongoing strategic planning of the clinical management programs.Develops and manages activities to ensure compliance with Federal, State, and NCQA accreditation standards.Oversees and participates in Performance Improvement Activities.Plans annual operating budget and monitors budget performance.Manages the development of policies and procedures, ensures implementation and adherence of same.Participates in information management and demonstrates proficiency in gathering, and accessing informationRepresents WellCare Health Services at various meetings and conferences on an ongoing basis.Recognizes and observes all company and departmental policies and procedures.Focuses on achieving departmental and organizational objectives.Provides proactive approach and support to emerging business activities established to remain competitive in the marketplacePreforms other duties as assigned Additional Responsibilities:Provides operational and strategic leadership for field clinical programs.Provides subject matter expertise to support operations, product development, and growth initiatives.Work collaboratively with medical directors and market leadership to deliver clinical programs that support the business objectives.Develops value propositions for clinical programs through quantitative analytics, ROI, and evidence-based data.Supports corporate Quality Improvement plan and market Quality Improvement plan to achieve target HEDIS results.Manages and develops direct reports who include directors and/or managers. Sets direction, allocates, and reallocates utilization of resources as required.Determines operational tactics to implement policies and strategies. Establishes reporting systems and controls to ensure compliance with company requirements.Provides oversight of and integration with vendors that touch on health service operations and serve market enrolleesSets overall goals, performance standards, and operational priorities for one or more functions and manages resources to operational goals and budget.Creates a motivated customer-service driven environment.Makes recommendations on matters of policy and approve changes in area of expertise.Provides leadership, oversight, direction and guidance of operations in Health Services clinical field management. Ensures that activities are carried out in a timely manner.Established market Health Services clinical management goals, strategy and objectives.Develops strategic plans with the ultimate goal to improve the health status of our members, measure outcomes, improve outcomes and subsequently reduce cost, consistent with the corporate and market goals and objectives of WellCare.Provides oversight of program analysis, which includes ongoing strategic planning of the clinical management programs.Develops and manages activities to ensure compliance with Federal, State, and NCQA accreditation standards.Oversees and participates in Performance Improvement Activities.Plans annual operating budget and monitors budget performance.Manages the development of policies and procedures, ensures implementation and adherence of same.Participates in information management and demonstrates proficiency in gathering, and accessing informationRepresents WellCare Health Services at various meetings and conferences on an ongoing basis.Recognizes and observes all company and departmental policies and procedures.Focuses on achieving departmental and organizational objectives.Provides proactive approach and support to emerging business activities established to remain competitive in the marketplacePreforms other duties as assigned Additional Responsibilities:Provides operational and strategic leadership for field clinical programs.Provides subject matter expertise to support operations, product development, and growth initiatives.Work collaboratively with medical directors and market leadership to deliver clinical programs that support the business objectives.Develops value propositions for clinical programs through quantitative analytics, ROI, and evidence-based data.Supports corporate Quality Improvement plan and market Quality Improvement plan to achieve target HEDIS results.Manages and develops direct reports who include directors and/or managers. Sets direction, allocates, and reallocates utilization of resources as required.Determines operational tactics to implement policies and strategies. Establishes reporting systems and controls to ensure compliance with company requirements.Provides oversight of and integration with vendors that touch on health service operations and serve market enrolleesSets overall goals, performance standards, and operational priorities for one or more functions and manages resources to operational goals and budget.Creates a motivated customer-service driven environment.Makes recommendations on matters of policy and approve changes in area of expertise.Provides leadership, oversight, direction and guidance of operations in Health Services clinical field management. Ensures that activities are carried out in a timely manner.Established market Health Services clinical management goals, strategy and objectives.Develops strategic plans with the ultimate goal to improve the health status of our members, measure outcomes, improve outcomes and subsequently reduce cost, consistent with the corporate and market goals and objectives of WellCare.Provides oversight of program analysis, which includes ongoing strategic planning of the clinical management programs.Develops and manages activities to ensure compliance with Federal, State, and NCQA accreditation standards.Oversees and participates in Performance Improvement Activities.Plans annual operating budget and monitors budget performance.Manages the development of policies and procedures, ensures implementation and adherence of same.Participates in information management and demonstrates proficiency in gathering, and accessing informationRepresents WellCare Health Services at various meetings and conferences on an ongoing basis.Recognizes and observes all company and departmental policies and procedures.Focuses on achieving departmental and organizational objectives.Provides proactive approach and support to emerging business activities established to remain competitive in the marketplacePreforms other duties as assigned Additional Responsibilities:Candidate Education:Required Bachelor's Degree in Nursing Candidate Experience:Required 10 years of experience in managed care industryRequired 8 years of experience in Leadership and management , preferably in a managed care environmentRequired Other Demonstrated expertise in Health Services, such as prior authorizartion, intake, concurrent review, case management, discharge planning including development and management of government programs experimence.Preferred Other Solid understanding and leadership experience with managed care quality improvement Candidate Skills:Advanced Ability to work independentlyIntermediate Ability to create, review and interpret treatment plansAdvanced Demonstrated organizational skillsAdvanced Demonstrated time management and priority setting skillsAdvanced Demonstrated leadership skillsAdvanced Demonstrated written communication skillsAdvanced Ability to effectively present information and respond to questions from peers and managementAdvanced Ability to implement process improvementsAdvanced Ability to analyze information and covert related activities into a comprehensive work planAdvanced Ability to influence internal and external constituentsAdvanced Ability to represent the company with external constituentsAdvanced Ability to work as part of a teamAdvanced Ability to lead/manage othersAdvanced Knowledge of community, state and federal laws and resourcesAdvanced Knowledge of healthcare deliveryAdvanced Knowledge of medical terminology and/or experience with CPT and ICD-9 coding Licenses and Certifications:Required Licensed Registered Nurse (RN)Preferred Certified Case Manager (CCM) Technical Skills:Required Intermediate Microsoft ExcelRequired Intermediate Microsoft WordRequired Intermediate Microsoft OutlookRequired Intermediate Microsoft PowerPointRequired Intermediate Healthcare Management Systems (Generic)About usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: Wellcare Health Plans, Tampa , VP, Field Health Services, Executive , Tampa, Florida

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