AVP, Dual Products

Job Summary:

The Associate Vice President, Dual Products collaborates closely with both Market and Corporate Leadership to ensure the effective delivery of care for multiple markets with high volume membership and/or complex populations. This role is instrumental in aligning local service operations with the organization's overarching goals, ultimately enhancing the quality of care for members within the assigned region.

Essential Functions:

• Accountable for collaborating with Market and Corporate Leadership to support the strategy and operations of dual product care management within multiple high volume and/or complex population markets, and to ensure alignment with organizational/business programs and processes in the markets.
• Responsible for providing direction and oversight of dual product care management activities across the continuum and coordination of care.
• Ensure programs and operational processes within regional markets are properly developed and aligned with the corporate Care Management model.
• Assign appropriate priorities according to the overall business plan.
• Lead, implement, develop, and support programs, systems, and processes to ensure consistent, effective, and efficient delivery of care to CareSource complex and dual product members while meeting state regulations and market financial objectives.
• Cultivate and promote the CareSource culture to improve the health outcomes of our members.
• Develop, implement, and monitor an accountability system and succession planning strategies.
• Monitor CQI activities and process improvement in accordance with regulatory requirements, URAC, HEDIS, NCQA, and future business needs related standards.
• Foster external and internal relationships with hospitals, physicians, community agencies, and key vendors.
• Budget responsibility related to clinical care, direct actions to control targeted costs for inpatient and outpatient services in conjunction with market Medical Directors and corporate clinical and analytics leadership.
• Review periodic reports (financial/utilization/services) to analyze trends, implement timely corrective action plans, and ensure consistent, accurate data according to established policies and procedures.
• Perform any other job related duties as requested.

Education and Experience:

• Bachelor's degree in Business, health care or other related field required
• Master's degree preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Ten (10) years of clinical operations leadership and/or case management, disease management, medical management, quality improvement, related experience required
• Five (5) years of senior level management experience required
• Five (5) years of Managed Care experience in a multi-market organization required
• Experience in a collaborative matrix environment preferred

Competencies, Knowledge and Skills:

• Microsoft Office proficiency
• Clinical data analysis and trending skills
• Knowledge of trends in healthcare, managed care, Medicaid/Medicare, long term-care, case/medical management, and quality improvement
• Strong knowledge of healthcare regulations, quality improvement methodologies, and population health management
• Excellent analytical, problem-solving, and decision-making skills
• Commitment to the mission and values of the CareSource Family of Companies
• Strong oral, written and interpersonal communication skills
• Knowledge of regulatory reporting and compliance requirements
• Excellent leadership skills

Licensure and Certification:

• Case Management or Managed Care certification and Certification in Healthcare Quality preferred
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• General office environment; may be required to s