Position Purpose: #This position has overall accountability and oversight of all Steward Health Choice Utah (SHCU) Health Plan clinical functions and medical cost trends consistent with the vision and strategy set forth by the senior executive leadership team. Actively involved in the shift towards a value-based, integrated delivery system in collaboration with strategic partners to ensure the delivery of the highest value healthcare services.
Establishes credibility and rapport to collaborate with a broad set of senior executives, clinicians, local government leaders, and community representatives. Participates and supports the communication, education, and maintenance of partnerships with contracted providers, provider physician groups, and may serve as the interface between the Health Plan and providers, regulators, etc. Mentors a high performing clinical team that focuses on clinical quality, service excellence, and business literacy.
Rallies support for the overall corporate vision and provides competitive clinical strategies and initiatives to ensure delivery of the highest value clinical and service outcomes of all communities to which the position is assigned. Responsible for the financial health of the Plan related to medical cost trends.# Collaborates with clinical leadership and key stakeholders to oversee the development and implementation of an effective care management infrastructure. Actively supports Quality and Compliance to ensure the Health Plan meets and exceeds medical management, quality, accreditation, regulatory, and agency standards.
Accountable for ongoing monitoring, measurement, and communication of medical management programs and processes (e.g. utilization management, care management, etc.); overseeing analysis of overall medical expense and performance data. Facilitates timely and specific clinical behavior modification that is both clinically sound and cost effective. Use population health and value-based care management in developing and evaluating systems that fully integrate care and reimbursement across the continuum of health care delivery.
Accountable for adoption of evidence based medical guidelines and protocols with proper stewardship of resources; analyzing members and population data to guide program direction. Participates in the medical management programs to assure that network providers deliver and members receive appropriate, high quality, and cost effective care through case reviews of prior authorizations, concurrent utilization review, appeals, disputes, state fair hearings, credentialing, etc. Responsible for recommending changes and enhancements after investigation of cases deviating from evidence-based and/or accepted practice standards and takes appropriate actions.
Leads the charge in focus and implementation of the organization#s culture and strategic plan in a way that aligns to the mission, vision and values of the organization. Performs other position appropriate duties as required in a competent, professional, and courteous manner. Equal Opportunity Employer Minorities/Women/Veterans/Disabled Education: ## ######## Bachelor
####s degree required
######## Minimum five (5) years of clinical practice experience required
(2) years of managed care experience strongly preferred
, ambiguous, and shifting environments, including a matrix management structure.
, tracking, and resource allocation to meet business objectives and timelines.
. Knowledge of methods used for improving employee performance/motivation.
, identify the best course of action and rapidly resolve complex issues/problems
/customer conflicts and complaints in a mutually satisfactory way
, and across differing cultural backgrounds #
New England Sinai Hospital And Rehabilitation Center