SVP-Care Management (Primarily Remote, North Carolina Based) (Project Management)

The Senior Vice President of Care Management is responsible for providing Strategic Planning, Budget Management, and Operational Leadership of all Care Management programs provided by Alliance Health.

This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to report to the Alliance Home Office (Morrisville, North Carolina) as needed for business meetings, at minimum one [1] day a week.  The desired candidates will be a resident of North Carolina or if currently residing out of state, able to relocate for the position. 

Responsibilities & Duties

Strategy Development/Innovation

• Design, develop and implement a strategic plan that focuses on clinical excellence and organizational goals
• Support continuous quality improvement and measure effectiveness on that plan to demonstrate clinical excellence 
• Coordinate and help develop Care Management Department quality improvement initiatives and execute action plans to achieve improvements in targeted domain 
• Collaboratively lead efforts to maintain the organization's focus and direction regarding model of care. This work should incorporate the clinical needs of all lines of business to achieve highest possible quality outcomes and operational efficiencies

Clinical Leadership/Oversight of Care Management Services and Operations

• Supervise Alliance Care Management services and operations, including Community Care Management, Transition Care Management, and care management of special populations
• Collaborate with colleagues to develop and implement Care Management Prevention and Population Health programs
• Ensure the delivery of effective, efficient, integrated and evidenced based services and interventions that include physical, behavioral, and social objectives
• Ensure the implementation of policies and procedures that maintain member rights
• Create and maintain proper operational controls, administrative and reporting procedures, and systems to meet and exceed clinical goals of the organization
• Ensure effective operations, support of organized care teams that deliver interventions and support under the care management model

Performance

• Maintain financial viability of Tailored Care Management program 
• Develop and implement standardization in measuring and monitoring operational and outcome metrics
• Monitor performance results against established metrics and benchmarks and recommend improvement opportunities

Compliance

• Ensure that all activities and operations are carried out in compliance with local, state, and federal regulation, Alliance Compliance Plan and all laws governing healthcare operations
• Work with Alliance's Legal, Compliance, Organizational Performance and Human Resource Divisions to ensure the department operates in compliance with URAC and NCQA procedures, proactively identifies agency risk, and implements corrective action when needed
• Responsible for establishing and implementing a safe working environment that meets all licensure, regulatory, and accreditation requirements

Oversee Department Staffing

• Work with Human Resources, departmental directors, managers, and supervisors to maintain a highly qualified and well-trained workforce  
• Ensure the proper allocation of resources to the highest priority deliverables
• Monitor and manage productivity and clinical integrity including caseloads, completed authorization requests, documentation
• Work with the IT department to ensure the department has the appropriate structure, tools, resources required to perform the job at the highest levels

Oversee Intradepartmental Cooperation

• Support enterprise-wide initiatives and effectively lead change
• Provide strategic direction on how to support exceptional experience for internal and external customers and stakeholders
• Actively work with cross functional departments to drive outcomes (claims, appeals, finance, IT, etc.)

Internal and External Collaboration and Communication

• Collaborate with medical directors and other clinical teams to address complex cases and high-risk members
• Provide timely and accurate reports to Alliance leadership, Board members, providers, the community, staff and stakeholders as needed about service trends, identified gaps and needs, recommended implementation of new processes, practices and effectiveness of clinical model  
• The SVP of Care Management represents the organization in various state forums, in meetings, with stakeholder, providers and consumers
• Navigate a matrixed environment

Minimum Requirements

Education & Experience

Master's degree in Psychology, Social Work, Counseling or Healthcare related field from an accredited institution with a minimum of seven (7) years of demonstrated care management/population health experience in a healthcare organization (health plan experience preferred) serving Medicaid beneficiaries, including experience with BH and I/DD populations 

Or

Bachelor's degree in Nursing or a relevant Healthcare related field from an accredited institution with a minimum of seven (7) years of demonstrated care management/population health experience in a healthcare organization (health plan experience preferred) serving Medicaid beneficiaries, including experience with BH and I/DD populations.

Must be Clinically Licensed in the state of North Carolina. 

Five or more years of progressive experience in senior level leadership is required. 

Knowledge, Skills, & Abilities

• Thorough Knowledge of managed care principles, behavioral healthcare/IDD service delivery, physical health service delivery, best-practices, and quality improvement.
• Thorough Knowledge of Medicaid regulations and standards with particular emphasis on quality (HEDIS/Star) measures
• Experience with Program planning, development, and implementation
• Ability to coordinate and direct employees and programs through an understanding of leadership skills, principles, techniques, and practices.
• Ability to analyze data, make independent decisions based on analysis, and report outcomes.
• Ability to direct the establishment of division goals and priorities and determine appropriate resources.
• Ability to develop and maintain satisfactory relationships with the target service population, general public, State, federal, and local officials, as needed

Want to learn more about what it's like work as part of the Care Management Team? Click on our video to learn more: https://youtu.be/1GZOBFx61QU 

Salary Range 

$193,310.40 to $241,638.00/Annually 

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.  

 An excellent fringe benefit package accompanies the salary, which includes:    

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility

Education

Required

• Bachelors or better in Health Services Administration

Licenses & Certifications

Preferred

• Lic Clinical MH Counselor
• Lic Clinical Social Wkr
• Lic Marr & Family Ther
• Lic Psychologist (LP)
• Registered Nurse

Skills

Required

• Leadership

Preferred

• Budgeting
• Coaching
• Communication
• Conflict Management
• Diplomacy
• Financial Analysis
• Implementation
• Influencing
• Interpersonal Skills
• Mentoring
• Planning

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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