[Hiring] Vice President, Population Health & Clinical Operations @Centene Corporation

Role Description

Plan, develop, and drive execution of medical management and quality improvement programs, processes, and initiatives to ensure improved quality outcomes, achievement of health benefit ratio targets, and reduction in administrative costs.

• Drive adoption of best practices and standardization, while developing customized approaches for unique markets and product lines.
• Oversee corporate accreditation, quality improvement, medical management operations, and new business development and implementation.
• Define medical management and quality improvement strategic and operating plans, balancing standardization with market or product specific solutions.
• Collaborate to evaluate medical trends and develop medical management and quality improvement initiatives to improve quality, achieve health benefit ratio targets, and reduce administrative costs.
• Drive discipline, consistency, and execution of standardized initiatives and best practices.
• Facilitate mechanisms to utilize pilots, measure results, and identify best practices to be used across health plans.
• Oversee the development and implementation of medical management policies and procedures to ensure NCQA and URAC standards.
• Develop and implement business plans to leverage technology to increase effectiveness and efficiency.
• Develop and implement standardized training, auditing, and work processes for new and existing business to ensure consistency and avoid redundant efforts.
• Develop and implement standardization in measuring and monitoring operational and outcome metrics.
• Facilitate integration and collaboration between the Health Plans and Specialty Companies related to medical management and quality improvement initiatives.
• Approximately 50% travel.

Qualifications

• Bachelor's Degree in business or healthcare related field.
• Master's Degree strongly preferred.
• 10+ years of experience working in a complex healthcare setting required.
• Expert understanding of Managed Care practices including utilization management, care management, clinical information systems, with strong financial acumen and focus, preferably in the governmental setting.
• Proficient in the use of project management tools and application of continuous process improvement methodologies such as Lean, Six Sigma or equivalent.
• Six Sigma certification strongly preferred.

Requirements

• Experience in a complex healthcare setting.
• Strong financial acumen.
• Proficiency in project management tools.
• Application of continuous process improvement methodologies.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field, or office work schedules.
• Total compensation may include additional forms of incentives.
• Benefits may be subject to program eligibility.