Senior Vice President, Medical Management
Company: Centene Corporation
Posted on: November 13, 2019
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
- Direct and coordinate utilization management; case and disease
management; provider performance and incentives; vendor delegation
oversight; and network key accounts maintenance and
- 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
- Monitor and assist vendors in successful completion of
corrective action plans. Prepare delegated vendors for Plan's NCQA
- 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
- Serve as a member of management committees on special
- 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
License/Certification: Registered Nurse. Certified Case Management
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
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