Summary
 

Position Purpose:

The Assistant Vice President, Medicaid Healthcare Management provides leadership, direction, and oversight (clinical operations) in the establishment of strategic direction for physical and behavioral health Utilization Management (prior authorization, inpatient review), Case Management, and Population Health. In this role, you will collaborate with internal and external partners in the development of various programs and strategies in support of current and emerging Medicaid business needs.

Description
 

Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 4101 Percival Road, Columbia, SC 29229. MUST RESIDE IN SOUTH CAROLINA.

What You’ll Do:

• Provides strategic direction and operations oversight of Medicaid physical and behavioral health medical management programs including Utilization Management, Case Management, Population Health, and Complex Case Management.  Achieves a positive return on investment for each program. 

• Completes annual strategic and operational plans, budgets, etc.  Implements and maintains monthly, quarterly, and annual performance monitoring to ensure compliance to contract, State, and Federal requirements/regulations

• Provides strategic direction and operations oversight to cutting edge programs and strategies for Medicaid Medical Management. 

• Provides direction, oversight, and management of any analytical projects and product/service development in support of Medical Management programs.

• Establishes, guides, and analyzes effective operations against benchmarks that are developed as measures of success. 

• Analyzes performance trends and develops new or modified work processes, decision support systems, reporting and benchmarks to improve overall operations quality, timeliness, member satisfaction, and financial outcomes.

• Mentors, guides and develops skills of management team members in a consistent and effective manner. 

• Establish and maintain staff productivity standards to ensure compliance with contractual, accreditation and regulatory requirements.

• Evaluates the clinical and economic impact of program and ensures all operations meet the program’s overall objectives and requirements.

To Qualify for This Position, You’ll Need:

Required Education:

• Master’s Degree or equivalent combination of education and work experience.

Required Work Experience:

• 10+ years of managed care experience with at least 5 years in direct Medicaid Managed Care.

• Experience working within applicable state, federal and third-party regulations.

• Experience meeting Quality Accreditation Standards (NCQA/HEDIS/STARS).

Required Skills and Abilities:

• Working knowledge of word processing software.

• Knowledge of quality improvement processes and demonstrated ability with these activities.

• Knowledge of contract language and application.

• Ability to work independently, prioritize effectively, and make sound decisions.

• Good judgment skills.

• Demonstrated customer service, organizational, and presentation skills.

• Demonstrated proficiency in spelling, punctuation, and grammar skills.

• Demonstrated oral and written communication skills. A