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AVP - Healthcare Management Services Job Details

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Company:  Nurse Resolutions
Job Code:  1562
Categories:  Skilled Nursing / Nursing Home (SNF)
Job Role:  Other
Country:  United States
Region/Province:  Nevada (NV)
City:  Las Vegas-Paradise
Job Description: 

JOB SUMMARY:
The Associate Vice-President Health Care Management Services manages the utilization / care management process ensuring the delivery of essential services that effectively address the total healthcare needs of Health Plan's members.

PRIMARY RESPONSIBILITIES:
1. Implements and manages health care management, utilization, cost, and quality objectives in accordance with the goals of Managed Care Corporation's mission, vision and values, the needs of the health plans, federal and state regulatory requirements and NCQA standards.

2. Collaborates with the peers to ensure a seamless interface between HCMS and Medical Management.

3. Identifies opportunities to improve the customer service and quality outcomes for our members.

4. Collaborates with peers to initiate innovative health care pilots to improve the overall HCMS/medical management program.
5. Interfaces with other departments to ensure the complete integration of behavioral health and physical health.
6. Overseas the development of medical management policies, procedures, and guidelines.
7. Ensures implementation and continued compliance by providing updates on specific medical management standards to Directors and staff.
8. Assists in developing clinical management guidelines including: Conducting literature search to identify “evidenced-based” management. Identifying changes in practice which may require updating of guidelines. Developing DRAFT guidelines as directed. Identifying national providers experienced in treating patients. Coordinating physician advisory groups

9. Ensures that delegated medical management activities are contracted, reviewed and reported according to established criteria.
10. Evaluates programs quarterly.
11. Supports and participates in quality initiatives and activities including clinical indicators reporting, focus studies and HEDIS reporting.

12. Ensures compliance with state reporting on utilization management activities for accuracy.
13. May develop the annual operating and capital budgets to sufficiently meet departmental needs.
14. Other duties as assigned.

Post Date:  05/24/2012
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