Vice President, Medical Management

Point32Health • Canton, MA

26d

About The Position

Who We Are Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health . Job Summary The Vice President of Medical Management, reporting to the Senior Vice President, Health Care Services is responsible for leading and transforming the medical management of in-patient, ambulatory and post-acute settings. This leader analyzes market trends and dynamics to identify opportunities and is responsible for developing and executing a multi-year strategy that aligns with the company's vision and goals. This position is accountable for evaluating internal operations against standard KPI designed to improve overall access to care, lower the total cost of care, and ensure high quality in compliance with all state and regulatory requirements. This role will be responsible for fiscal and administrative oversight of a large internal team focused on industry standard productivity measures while consistently delivering high inter-relator reliability. This leader is also responsible for developing clinical platform strategy to meet the current and prospective regulatory requirements for automation and inter-operability.

Requirements

• Advanced degree in related field required.
• Active clinical licensure preferred but not required
• 10-15 years of progressive business and leadership experience in health care and/or managed care.
• 10+ years of leadership experience, supervising high-level professionals required, with demonstrated success in program development and execution
• Experience in leading and transforming the medical management of in-patient, ambulatory and post-acute settings
• Demonstrated success with design and execution of clinical system strategy and automation functionality
• Experience in leading and transforming the medical management of in-patient, ambulatory and post-acute settings
• Ability to plan and act strategically
• Skilled in taking calculated risks
• Excellent quantitative skills and strong analytic background preferred
• Must possess strong leadership skills with proven ability to achieve goals and deliver bottom line results
• Proven ability to coach, motivate, and inspire staff
• Excellent communication, presentation, and negotiation skills, as well as organizational, analytical, and critical thinking skills
• Ability to work cross-functionally, supporting multiple, simultaneous objectives
• Ability to build internal programs including detailed workflows and corresponding key performance indicators and metrics
• Superb customer service focus; ability to foster teamwork as an attitude and a skill; willingness to be a change agent

Responsibilities

• Provide leadership and mentoring to the medical management team, fostering a culture of innovation and continuous improvement.
• Oversee and lead the design, implementation and delivery of key strategies aimed at ensuring consistent, efficient, and impactful UM programs
• Develop comprehensive strategy to position Point32Health as a leader in utilization management and effectiveness, including pre-service, concurrent post-service reviews and transitions of care.
• Lead ROI strategic UM initiatives, including business case development, implementation and monitoring of medical and administrative cost savings strategies to support evidence-based trend management in conjunction with outcome driven KPI’s
• Ensure departmental compliance with all regulatory and accreditation agency standards for state and federal requirements.
• Work in collaboration with IT to develop future capabilities with respect to PA automation and interoperability.
• Identify system needs, and improve internal efficiencies
• Collaborate with compliance to ensure consistent internal auditing for all regulatory processes, lead all corrective actions stemming from an audit.
• Identify key utilization trends that could impact the organization's financial and/or operational performance
• Ensure routine assessment of all metrics measured support internal and external factors that could affect performance
• Provide leadership and mentorship to the medical management team, fostering a culture of innovation and continuous improvement.
• Collaborate with stakeholders throughout the organization to identify opportunities and develop strategic partnerships
• Manage UM departmental budget, identifying ongoing opportunities to drive administrative efficiencies through automation and workflow redesign
• Other projects and duties as assigned.

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

What This Job Offers

• Job Type: Full-time
• Career Level: Executive
• Number of Employees: 1,001-5,000 employees