Vice President, Health Care Management

Lancaster, PA
Apr 19, 2017
Apr 21, 2017
Full Time
For more than 30 years, CoreSource has been delivering customized employee benefit administration services to self-funded employers across the United States.#JD Each of our offices around the country is managed locally, by industry veterans who understand the dynamics of the markets they serve. #JDEvery CoreSource office delivers the personal attention of a local TPA, backed by the resources and innovation of a large national organization, The Trustmark Companies. #GDWe are currently in search of a seasoned HealthCare Management professional for the role of Vice President Health Care Management.This position can be located in either Lancaster, Pennsylvania or our corporate headquarters in Lake Forest, Illinois.As the Strategic Clinical Leader for CoreSource you will be providing clinical expertise and business direction in support of health management programs to promote the delivery of high quality, consumer centric medical care. This position will provide critical medical and business leadership both with internal and external clients and strategic partners.Act as lead business and clinical thought leader to determine CoreSource's clinical strategy, use of analytics in health care management and network strategies with providers and facilities to support improved health and provide top quartile medical management results for our clients.Provide clinical guidance in the design and operation of effective health programs to promote member quality of care and in reviewing potential lapses in the quality of care.Provide oversight, leadership and direction for the healthcare management functions lead by the clinical teams to include: Participate in quality management activities at regional and market levels including those necessary to achieve/maintain NCQA and URAC accreditation Proactively use data analysis, predictive modeling and medical cost forecasting capabilities to identify opportunities for quality improvements and to positively influence the cost effective delivery of quality care. Work collaboratively with CoreSource's executive team and the regional leaders that interface with medical management including clinical operations, provider contract management, client and partner contracting, member services, sales, benefits and claims management, product & marketing, and sister companies to achieve CoreSource's business goals. Lead clinical staff in assuring members' care is coordinated in a fashion that achieves the most value for the available benefits and that an advocate is available to the member and their caregiver for coordination of benefits.Provide clinical expertise and business direction in support of health management programs through participation in clinical team activities in the execution of precertification, concurrent review/discharge planning, appeals, case management, disease management, and quality management. Including direct participation with plan sponsors, providers, facilities and vendors as required.Partner with medical management leadership to increase effectiveness of medical management programs and to promote the integration of other vendor partner medical programs.