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Senior Vice President, Medical Management

Position Purpose: Oversee and coordinate the medical management, vendor delegation oversight, provider performance and key accounts relations. Support the company's strategic plan, establish the strategic vision and ensure policies and procedures are maintained.
Direct and coordinate utilization management; case and disease management; provider performance and incentives; vendor delegation oversight; and network key accounts maintenance and relations.
Responsible for the development, execution and monitoring of vendor performance metrics.
Formulate and administer health plan departmental policies. Collaborate with corporate staff in administering organizational and departmental policies.
Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives. Work with delegated vendors to achieve set targets supportive of Plans overall goals.Monitor and assist vendors in successful completion of corrective action plans. Prepare delegated vendors for Plan's NCQA accreditation.
Responsible for the execution and monitoring of provider incentive plans. Monitor provider performance and HBR. Meet with providers quarterly to review incentive performance and HBR; make recommendations on interventions leading to better incentive outcomes for participating providers.
Create and maintain collaborative partnerships with key accounts (large medical groups and hospital consortiums). Work to establish collaborative relationships by fostering excellent customer response and quick, appropriate problem resolution.
Serve as a member of management committees on special studies.
Administer and ensure compliance with National Committee on Quality Assurance (NCQA) and/or Joint Commission on Accreditation of Healthcare Organization (JACHO) standards as determined for accreditation of the health plan.
Participate in, attend and plan/coordinate staff, departmental, committee, sub-committee, community, State and other activities, meetings and seminars.
Participate in provider education and contracting.
Education/Experience: Bachelor's degree in Nursing or related field. 10 years of experience with health plan operations. Previous experience with plan operations, quality improvement practices and development of strategic initiatives to enhance plan's performance. Familiarity of medical information systems, medical claims payment process, medical terminology and coding. Working knowledge of case management practices, managed care, and Medicaid programs. Working knowledge of National Committee on Quality Assurance (NCQA) accreditation process and standards. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
License/Certification: Registered Nurse. Certified Case Management (CCM)
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.



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