The Vice President - Clinical is responsible for providing the strategic guidance, direction and overall management of the Care Management function and processes across Healthfirst products. This position oversees efforts to improve member outcomes – in functional capability, health services utilization, quality of life, and other important outcomes as measured by external quality measurement programs. The VP seeks to improve the member experience with healthcare services and with the care management process. He/she provides leadership to manage administrative costs for his/her areas and uses data and metrics to drive constant process improvement.
Sets the strategy, direction, and goals for all of the Management function with an eye towards quality of service, productivity and process improvement.
Serves as the subject matter expert (SME) for care management contributing to interpretation and guidance for new and emerging rules and regulations at both the state and federal level
Partners with other clinical and operational leaders to drive consistency in process and member experience across Healthfirst departments.
Uses internal and external benchmarks to drive high-quality outcomes and efficient processes.
Actively participates in driving Quality and Population Health improvement efforts within care management teams and more broadly across the organization.
Ensures compliance with all organizational policies, procedures and regulatory requirements on behalf of the Care Management function.
Builds a high performing team that is organized and staffed effectively.
Integrates the Care Management function into Utilization Management and other department workflows to support the coordination of care.
Informs policy, product and process decisions across HF from the CM perspective.
Additional duties as assigned
Regulatory or Compliance activities: Ensures compliance with all organizational policies, procedures and regulatory requirements on behalf of the Care Management function.
10 years of experience within Care Management
5 years of direct leadership experience
Experience within a Matrixed organization
BSN and a licensed Registered Nurse in New York or eligible
Leadership experience in Care Management
Work experience providing mid to long-term strategic and tactical direction and operational oversight.
Experience managing and developing large teams.
Experience within realty-based leadership.
Progressive leadership experience in a health care environment
Knowledge of Managed Long-Term Care, Medicare, and Mainstream Medicaid health-care regulations, legislation and laws
Grant Cooper is a retained executive search firm working principally in healthcare to identify and recruit superior executive talent for our clients nationwide. The firm is ranked as one of the top 10 healthcare executive search firms in the US.