Vice President, Clinical Care Services

Location
Norfolk, VA
Salary
Competitive
Posted
Mar 21, 2019
Closes
Apr 17, 2019
Ref
122075BR
Function
Other
Industry
Other
Hours
Full Time
Overview:

Optima Health is hiring an experienced leader to serve in the role of Vice President, Clinical Care Services in Norfolk, VA.

The desired candidate will provide extensive leadership to include both of our government programs - Medicaid and Medicare.



Division Highlights:

Optima Health offers a full suite of commercial health insurance products including employee-owned and employer-sponsored plans, as well as Individual and Family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services.

As a nationally recognized provider of health plan coverage and innovative wellness programs, we live our mission "to improve health everyday." This same commitment and dedication directs our philosophy as an employer. When you join Optima Health, you will experience our deep passion for heal and service excellence while benefiting from a culture of opportunity, learning, career growth, and support --every day. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.


Sentara Benefits:

Sentara employees strive to make our communities healthier places to live. We’re setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, CLICK HERE!

Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!

Other
Case Management experience is defined as management Case Management and/or Utilization Management functions within a health plan specific to government programs (i.e. Medicaid, Medicare, DSNP, LTSS, etc) Graduate of an accredited school of clinical practice such as professional nursing, counseling or social service. All licenses must be maintained in area of specialty.

Keyword: clinical care services, leader, Medicare, Medicaid, health plan, mco

Equal Opportunity Employer
Sentara maintains a drug free workplace

Responsibilities:

Responsible for oversight of Optima's Government Program Clinical Care Services (CCS) programs including Medicaid, Medicare, Optima Health Community Care, and the Medicare Dual Special Needs Plan (DSNP). Clinical Care Services includes direct Clinical Care Coordination and Case Management, Behavioral Health, Disease Management, Utilization Management, and Clinical Pharmacy Management, according to State and Federal regulations, and contracted services including the Model of Care. Provides strategic and operational leadership to the CCS workforce in delivering innovative and excellent quality clinical support programs and services to Optima members with the goal of improving health every day. Maintains a solid grasp of the national healthcare industry, best practices, and provides leadership to program design and development. Works closely with the VP, Clinical Care Services Commercial and Shared Services to insure coordination, collaboration and program consistency across Optima Clinical Services. Represents Optima as a senior leader with state and federal government programs, and across the integrated Sentara Healthcare team. Accountable for managing the medical/loss ratio within Optima's vision, guiding principles and financial objectives.

Qualifications:

Education Level
Master's Level Degree

Experience
Required: Case Management - 3 years, Health Insurance Plans - 3 years, Healthcare - 5 years, Managed Care - 5 years

Preferred: None, unless noted in the "Other" section below

License
None, unless noted in the "Other" section below

Skills
Required:

Preferred: None, unless noted in the "Other" section below

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