What are the responsibilities and job description for the Regional VP Health Services Mid-Atlantic Region position at CLevelCrossing?
Regional VP Health Services Mid-Atlantic Region
Location : Bethesda, MD, United States
Posted on : Feb 21, 2022
Profile
The Regional VP, Health Services relies on medical background and reviews health claims. The Regional VP, Health Services requires an in-depth understanding of how organization capabilities interrelate across segments and / or enterprise-wide.
Responsibilities :
- Serve as the Senior Physician for the Mid-Atlantic region, creating, implementing, and overseeing the clinical strategy.
- Provide medical leadership and strategy for the region's Health Services Operations (HSO), including fiscal responsibility for managing medical cost trends.
- Oversee regional utilization management for various case types and ensure compliance with the Humana Medicare Model of Care.
- Supervise the region's Lead Medical Directors and Medical Directors.
- Review and approve administrative budget and expense reports for the regional HSO.
- Oversee clinical and quality metrics with PCP offices and IPAs, coordinating operational and clinical activities.
- Participate in regional or Humana national level committees related to medical necessity determination processes.
- Provide oversight for the implementation of regional clinical programs and market-level strategies.
- Manage internal operational relationships related to profitability.
- Assist with network development and provider contracting.
- Act as clinical liaison in meetings with inpatient facilities and provider joint operating committees.
- Understand financial aspects of various levels of risk-bearing contracts.
- Thrive in a highly matrix environment.
Required Qualifications :
Covid-19 Requirements : You are required to be fully COVID vaccinated, or commit to weekly COVID testing and follow safety protocols as required.
Preferred Qualifications :
Location : In-office or WAH with strong preference for Richmond, VA, but must reside within the market (VA, MD, DC, DE, NC).
Scheduled Weekly Hours : 40
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