AustinRecruiter Since 2001
the smart solution for Austin jobs

Senior Vice President, Medical Management

Company: Centene Corporation
Location: Spicewood
Posted on: November 13, 2019

Job Description:

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.

Keywords: Centene Corporation, Austin , Senior Vice President, Medical Management, Executive , Spicewood, Texas

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Utilization Manager
Description: Position Purpose: Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, provide and x2F or (more...)
Company: Centene Corporation
Location: Manchaca
Posted on: 12/13/2019

Partner Account Manager, SHI
Description: br Partner Account Manager, SHI br br US-TX-Austin br br Title: Partner Account Manager- SHI br br Job ID: 2019-4544 br Type: Permanent Full Time br of Openings: 1 br Category: (more...)
Company: Mimecast Services Limited
Location: Austin
Posted on: 12/13/2019

Application Modernization Product Manager
Description: Product Management Practice Lead --Round Rock, TexasWhy Work at Dell Dell provides the technology that transforms the way we all work and live. But we are more than a technology company ------ we are (more...)
Company: Dell
Location: Round Rock
Posted on: 12/13/2019


Change Management Lead
Description: Dell provides the technology that transforms the way we all work and live. But we are more than a technology company ------ we are a people company. We inspire, challenge and respect every one of our (more...)
Company: Dell
Location: Round Rock
Posted on: 12/13/2019

Manufacturing Manager II
Description: WE'RE DRIVING TOWARD THE ULTIMATE VICTORY: A WORLD WITHOUT THE FEAR OF CANCER.Produce high quality products, safely, on time for the customer at the lowest cost br Manufacture products to the highest (more...)
Company: Varian Medical Systems, Inc.
Location: Austin
Posted on: 12/13/2019

Change Management Lead
Description: Dell provides the technology that transforms the way we all work and live. But we are more than a technology company ------ we are a people company. We inspire, challenge and respect every one of our (more...)
Company: Dell
Location: Leander
Posted on: 12/13/2019

Partner Management Planning Consultant-Round Austin, TX
Description: Dell provides the technology that transforms the way we all work and live. But we are more than a technology company we are a people company. We inspire, challenge and respect every one of our over 100,000 (more...)
Company: Dell (UK)
Location: Austin
Posted on: 12/13/2019

Application Modernization Product Manager
Description: Product Management Practice Lead --Round Rock, TexasWhy Work at Dell Dell provides the technology that transforms the way we all work and live. But we are more than a technology company ------ we are (more...)
Company: Dell
Location: Cedar Park
Posted on: 12/13/2019

Case Manager RN-Emergency Department
Description: We Are Hiring Case Manager RN--- Part-Time, EveningMonday-Friday6:00p 10:00--Dell Seton Medical Center - Austin, TXWhy Join Ascension Ascension Seton, based in Austin, Texas, is a faith-based non-profit (more...)
Company: Ascension, A53
Location: Austin
Posted on: 12/13/2019

Senior Project Manager - Transportation Engineering and Planning
Description: 24983BR Business Unit NAU Job Description Manage TxDOT transportation planning, corridor planning, NEPA and traffic engineering projects Conduct business development efforts for transportation projects (more...)
Company: CDM Smith
Location: Austin
Posted on: 12/13/2019

Log In or Create An Account

Get the latest Texas jobs by following @recnetTX on Twitter!

Austin RSS job feeds