Associate Vice President, Health Plan(Must live in Ohio, Preferred Experience In Special Needs Plans, Clinical Operations)

Job Summary:

The Associate Vice President, Care Management is responsible for the strategic leadership and operational oversight of health plan and clinical services. This role involves developing and implementing innovative programs that enhance the quality of care, improve operational efficiency, and ensure compliance with regulatory requirements. The AVP will collaborate with cross-functional teams to drive initiatives that align with the organization’s mission and goals.

Essential Functions:

• Accountable for collaborating with Market and Corporate Leadership to support the strategy and operations of care management within the assigned market(s), and to ensure alignment with organizational/business programs and processes in the market(s)
• Responsible for providing direction and oversight of care management activities across the continuum of coordination of care
• Ensure programs and operational processes within the market(s) are properly developed and aligned with the corporate Care Management model
• Lead, implement, develop, and support programs, systems, and processes to ensure consistent, effective, and efficient delivery of care to CareSource members while meeting state regulations and market financial objectives
• Cultivate and promote the CareSource culture to improve the health outcomes of our members
• Develop, implement, and monitor an accountability system and succession planning strategies
• Foster external and internal relationships with hospitals, physicians, community agencies, and key vendors
• Budget responsibility related to clinical care, direct actions to control targeted costs for inpatient and outpatient services in conjunction with market Medical Directors and corporate clinical and analytics leadership
• Review periodic reports (financial/utilization/services) to analyze trends, implement timely corrective action plans, and ensure consistent, accurate data according to established policies and procedures
• Perform any other job duties as requested.

Education and Experience:

• Bachelor of Science/Arts Degree or equivalent years of relevant work experience is required
• Master’s degree in Public Health, Healthcare Administration, Business Administration preferred.
• Minimum of ten (10) years of experience in health plan operations, clinical management, or a related field is required.
• Minimum of five (5) years of leadership/management experience is required.

Competencies, Knowledge and Skills:

• Strong knowledge of healthcare regulations, quality improvement methodologies, and population health management.
• Excellent analytical, problem-solving, and decision-making skills.
• Exceptional communication and interpersonal skills, with the ability to engage and influence stakeholders at all levels.
• Proven track record of leading successful initiatives that drive operational excellence and improve member outcomes.
• Proficient with Microsoft Office, including Outlook, Word and Excel
• Prior experience with and knowledge of case management documentation and managed care systems required
• Excellent leadership, management and supervisory skills

Licensure and Certification:

• Current, unrestricted license in the state of practice as a Registered Nurse (RN), Licensed Independent Social Worker (LISW), Psychologist, or Licensed Professional Clinical Counselor (LPCC) is required
• Employment in this position is conditional pending successful clearance of a driver’s license record check.  If the driver’s license record results are unacceptable, the offer will be withdrawn or, if  you have started employment in this position, your employment in this position will be terminated
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• May be required to travel 25% to 50% of the time to perform work duties; a valid driver’s license, car and automobile insurance are necessary for work-related travel
• General office environment; may be required to sit or stand for extended periods of time

Compensation range $150,000-$300,000.  CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Energize and Inspire the Organization

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.