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Vice President, Medical Management
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- The VP of Medical Management is responsible for the Utilization Management (UM) and Care Management (CM) functions for health plan members.
- This position is responsible for integrating efforts across teams, programs, and improvement activities for all lines of business to promote optimal organizational effectiveness and enhance performance.
- Lead Care Management, Utilization Management and Health Promotion and Wellness departments for optimal performance against national benchmarks; create a multi-year improvement plan which includes various programs across lines of business (e.g. complex case management and condition support) aimed to sustain a scalable and flexible model aligned with Population Health Management.
- Develop and incorporate performance-enhancing systems and tools for increased automation and efficiency in the scope of work specified for increasing operational excellence (e.g., Machine learning algorithms, ePA deployment, use of bots and Artificial Intelligence to streamline operations)
- Maintain strong and collaborative relationships with the leadership of internal and external stakeholders (e.g., Pharmacy, Quality, Provider Network, IT, Operations, Customer Care, Line of Business and Regional leaders and other identified stakeholders) to address all aspects of CM/UM and total cost of care.
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