Vice President, PHCO & Utilization Management
Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.
Position Purpose:
Plan, develop, and drive execution of medical management and quality improvement programs, processes, and initiatives to ensure improved quality outcomes, achievement of health benefit ratio targets, and reduction in administrative costs. Drive adoption of best practices and standardization, while developing customized approaches for unique markets and product lines. Oversee corporate accreditation, quality improvement, medical management operations and new business development and implementation.
• Overseeing Clinical Prior Authorization and Health Supports teams for all Lines of Business
• Ensuring meeting turn around times
• Oversee medical management strategic and operating plans, balancing standardization with market or product specific solutions towards managing cost and quality.
• Collaborate to evaluate medical trends and develop medical management and quality improvement initiatives to improve quality, achieve health benefit ratio targets, and reduce administrative costs.
• Drive discipline, consistency, and execution of standardized initiatives and best practices.
• Facilitate mechanisms to utilize pilots, measure results, and identify best practices to be used across health plans.
• Oversee the development and implementation of medical management policies and procedures to ensure NCQA and URAC standards.
• Develop and implement business plans to leverage technology to increase effectiveness and efficiency.
• Develop and implement standardized training, auditing, and work processes for new and existing business to ensure consistency and avoid redundant efforts.
• Develop and implement standardization in measuring and monitoring operational and outcome metrics.
• Facilitate integration and collaboration between the Health Plans and Specialty Companies related to medical management and quality improvement initiatives.
• Approximately 25% travel.
Education/Experience:
Bachelor's Degree in business or healthcare related field.
Master's Degree strongly preferred.
10+ years of experience working in a complex healthcare setting required.
Expert understanding of Managed Care practices including utilization management, care management, clinical information systems, with strong financial acumen and focus, preferably in the governmental setting.
Operations experience preferred:
Proficient in the use of project management tools and application of continuous process improvement methodologies such as Lean, Six Sigma or equivalent.
Six Sigma certification strongly preferred.
Pay Range: $250,000 - $480,000
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
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Position Purpose:
Plan, develop, and drive execution of medical management and quality improvement programs, processes, and initiatives to ensure improved quality outcomes, achievement of health benefit ratio targets, and reduction in administrative costs. Drive adoption of best practices and standardization, while developing customized approaches for unique markets and product lines. Oversee corporate accreditation, quality improvement, medical management operations and new business development and implementation.
• Overseeing Clinical Prior Authorization and Health Supports teams for all Lines of Business
• Ensuring meeting turn around times
• Oversee medical management strategic and operating plans, balancing standardization with market or product specific solutions towards managing cost and quality.
• Collaborate to evaluate medical trends and develop medical management and quality improvement initiatives to improve quality, achieve health benefit ratio targets, and reduce administrative costs.
• Drive discipline, consistency, and execution of standardized initiatives and best practices.
• Facilitate mechanisms to utilize pilots, measure results, and identify best practices to be used across health plans.
• Oversee the development and implementation of medical management policies and procedures to ensure NCQA and URAC standards.
• Develop and implement business plans to leverage technology to increase effectiveness and efficiency.
• Develop and implement standardized training, auditing, and work processes for new and existing business to ensure consistency and avoid redundant efforts.
• Develop and implement standardization in measuring and monitoring operational and outcome metrics.
• Facilitate integration and collaboration between the Health Plans and Specialty Companies related to medical management and quality improvement initiatives.
• Approximately 25% travel.
Education/Experience:
Bachelor's Degree in business or healthcare related field.
Master's Degree strongly preferred.
10+ years of experience working in a complex healthcare setting required.
Expert understanding of Managed Care practices including utilization management, care management, clinical information systems, with strong financial acumen and focus, preferably in the governmental setting.
Operations experience preferred:
Proficient in the use of project management tools and application of continuous process improvement methodologies such as Lean, Six Sigma or equivalent.
Six Sigma certification strongly preferred.
Pay Range: $250,000 - $480,000
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Apply tot his job
Apply To this Job