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Company Overview

Visionworks (formerly Eye Care Centers of America, Inc.) is a leading provider of eye care services with more than 590 optical retail stores in 40 states and the District of Columbia through 5 store names that are leaders in eye care service in each of their respective markets. Visionworks is committed to providing our customers with an excellent shopping experience and high quality products and service with the best value and selection in the industry. All of our stores offer designer and exclusive brand frames, lenses, sunglasses and accessories along with leading technology in vision correction. Our comprehensive service offerings include contact lens dispensing, in-store labs which provide one-hour service on many prescriptions at nearly all locations and doctors of optometry at or next to every store. Visionworks is a wholly owned subsidiary of HVHC, Inc.

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VP, Clinical Standards
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Job Description



VP, Clinical Standards
Summary:
The Vice President Clinical Standards will be responsible for the development, implementation and oversight of professional and clinical standards and protocol; utilization management and peer review programs. He/she will support internal associates and clients in clinical matters.
 
The Vice President Clinical Standards will collaborate with the other HVHC executives in order to reach the firms stated key strategic initiatives which include:

•          Enhance “One HVHC” as a total integrated vision solution company seizing appropriate opportunities for growth and investment.

•          Continuously enhance the customer focus/customer experience.

•          Expand stores where HVHC has managed vision care lives, and increase managed vision care lives where HVHC has retail stores.

•          Ensure consistent, sustained and controlled growth.

•          Continue the integration of the HVHC families of businesses…retaining the unique brand properties “in front of the customer” while looking for efficiencies and synergies behind that which the customer sees.



Job Requirements


1.       Direct the prospective, concurrent and retrospective utilization review of all requests requiring professional judgment.
2.       Assist QA associates in collecting and interpreting clinical information relevant to review and resolution of member and provider complaints, grievances and appeals.
3.       Coordinate Credentialing Committee activities.
4.       Development and management of file audit systems; establish protocols.
5.       Participate in the development and periodic review of policies and procedures related to Credentialing, Utilization Management, Quality Management, Clinical Care and NCQA standards.
6.       Establish and operationalize standards, policies and procedures for written documentation, forms and communication, i.e. HIPAA consent, examine form, etc.
7.       Serves as the Subject Matter Expert on store design and set-up as related to ADA, QA, UR and other medical/clinical requirements in conjunction with VP Legal/Compliance.
8.       Supports and maintains a team of Regional Quality Assurance Representatives (RQAR) comprised of independently contracted licensed Optometrists and Ophthalmologists to perform key functions within the Quality and Utilization Management programs. Coordinate activities of all Regional Quality Assurance Representatives.
9.       Support the development and implementation of wellness and disease management programs in partnership with MCO clients.
10.    Work with the Manager of Healthcare Informatics to utilize available data to identify industry trends and develop relevant interventions and program enhancements.
11.    Be available for and participate in presentations to existing and potential clients as requested by Davis Vision sales departments; i.e., Finalist presentations.
12.    Contribute as a key member of the Professional Services team to address and achieve the strategic goals of the department and organization.
13.    Develop and maintain a working knowledge of the statutes and laws, including State Credentialing Statutes, NCQA Accreditation Standards.
14.    Participate in Regional and National Business meetings as required.
15.    Assume additional responsibilities, including committees and special projects as needed or directed.
Education:

•         Doctor of Optometry required. Must possess current state licensure (not necessarily in Texas)


•         Master’s Degree in Quality Management or relevant certifications in Public Health
Experience & Background:

•          Minimum 5 years in Healthcare, Insurance, Managed Care and/or Provider Services.

•          Must possess prior management experience at the executive level as well as direct project teams.
Language Skills:

•          Outstanding oral and written communication skills
Mathematical Skills:
 
Reasoning Ability

•         Strong Analytical skills with strong trend and pattern recognition

•         Able to create, maintain and interpret detailed data into a summary analysis and action points

We are an Equal Opportunity Employer. We do not discriminate on the basis of race, color, sex, religion, national origin, age, disability, sexual orientation, or any other characteristic protected by federal, state, or local law. The Company will attempt to make every effort to make reasonable accommodations to known physical or mental limitations of qualified applicants or associates with disabilities, unless accommodation would impose an undue hardship on the operation of our business. EOE AA M/F/Vet/Disability.




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