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VP, Clinical Executive Director

Beacon Health Options • US-Nationwide

Posted 1 month ago

Job Snapshot

Full-Time
Degree - Graduate Degree
Other Great Industries
Executive, Management

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic VP, Clinical Executive Director to join our team at our office in Little Rock, AR. The VP, Clinical Executive Director will be responsible for the direction and leadership of integrated behavioral health, physical health and pharmacy services for the AR PASSE program.   The VP Clinical Executive Director is the primary owner of medical and clinical strategy in the market responsible for taking utilization and other data and driving strategic interventions; responsible for management of medical risk; and management of total medical expenditure. The VP Clinical Executive Director is accountable for the development and management of strategies to manage medical loss ratio issues; and the monitoring of utilization data and trends. S/he will work closely with the Chief Financial Officer and Medical Management teams to develop and execute clinical and network strategies designed to manage cost and improve the quality of care to PASSE members. This position will have oversight of the operational non-clinical and clinical teams ensuring all systems are in place to meet regulatory and clinical best practices.  Supervises the AVP Clinical Operations who oversees the day- to- day operations of managing a team of nearly 300 people in the market including: delegation oversight of vendors; workflow/process management; staffing; utilization management; care coordination and compliance with clinical deliverables in the contract.

Position Responsibilities:

Duties and Responsibilities:

  • Deliver effective and efficient clinical, quality, and provider strategy operations

    • Responsible for developing an integrated approach to patient and population management across the continuum of care for child and adolescent, IDD and adult SMI members.

    • Provide clinical and strategic oversight of medical UM and pharmacy partner

    • Responsible for developing and achieving administrative and medical costs budgets for the AR PASSE program in collaboration with the Chief Financial Officer

    • Chair or assign designee for regional clinical, quality and provider Strategy team meetings

    • Develop and lead the strategic clinical vision for the AR PASSE program through engagement the internal team; vendor partners; providers and the Empower Board

    • Develop and execute strategic network partnerships and activities designed to improve clinical outcomes and contain cost of care

    • Work with the account team, the CMO and the growth officer in the region ensuring clinical and quality requirements are met.

  • Responsible for monitoring performance

    • Develop analytics to measure and track Total Medical Expenditure (TME)

    • Develop strategic plan to address TME outcomes

    • Meet Medical Loss Ratio (MLR) and clinical quality targets in collaboration with the clinical, medical, and operational leadership teams.

    • Develop and apply analytics to measure impact of clinical program and identify opportunities for improvement

    • Monitor, analyze, and report on trending of utilization data, to recommend targets; to assess performance against established targets; and to facilitate effective interventions where variance from UM targets may be identified locally or regionally

    • Ensure that performance metrics across all clinical, quality, and provider quality are accurately and consistently monitored

    • Continuously monitor utilization management productivity and other operational metrics for region; identify issues related to changes in productivity; direct and oversee appropriate interventions to manage productivity to targets

    • Continuously monitor processes and procedures and develop recommendations to create efficiencies; direct and oversee recommended changes to processes and systems

    • Collaborate with UM functional area, Reporting and Analytics, and Finance for implementation and tracking of targeted intervention strategies and pricing/target feedback

Position Requirements:

Education: A minimum of a Master’s Degree in a related field (Business Administration, Healthcare Administration, behavioral sciences etc.); PhD preferred but not required.

Licensure:   Current, valid and unrestricted clinical licensure required with proof upon hire

Relevant Work Experience: 

  • Minimum of ten years managed health care experience. Preference will be given to candidates who have worked within a managed care health plan setting.

  • Leadership experience in health system performance including TME analysis and management; spending and alternate payment methods (global payments, limited budgets, and bundled payments); data analytics and predictive modeling.

  • Experience in pharmacy benefit management highly desirable

  • Senior-level experience with operations and UM; fluency in clinical operations and driving operational efficiencies while managing resulting impacts to MLR; and understanding of regulatory and accreditation requirements necessary.

  • Fundamental Skills:

    • The candidate must have excellent written, verbal communication and negotiation skills, superior data analytic skills, and experience using management information systems.

    • Demonstrated leadership skills and supervisory experience, including the ability to work cross-functionally, build consensus, develop team performance and manage external vendor relationships

    • Self-motivated, able to prioritize multiple issues, excellent organizational skills, ability to track multiple projects/tasks and follow through as needed.

    • Ability to manage time-sensitive projects and meet deadlines

    • Ability to identify opportunities for improvement and recommend and implement innovative solutions.

    • Able to work collaboratively with internal staff and external providers and partners

    • Must be detail oriented; able to work independently in an ever changing environment

Knowledge, Skills & Abilities:

  • Proficient technical skills

  • Excellent written and verbal communication skills

  • Excellent analytical skills

  • Group presentation and public speaking skills

  • Matrix management experience

TO APPLY

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

$NFD

#CB

PM16

#GD

$REM

Job ID: 57040
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