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Senior Vice President, Medical Management

Company: Centene Coproration
Location: Austin
Posted on: January 17, 2020

Job Description:

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.

Keywords: Centene Coproration, Austin , Senior Vice President, Medical Management, Healthcare , Austin, Texas

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