Vice President, Clinical Operations- CHOICE Health Plans
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POST DATE 9/13/2016
END DATE 10/12/2016
Visiting Nurse Service Of New York
Created in 1998, VNSNY CHOICE is the managed care affiliate of the Visiting Nurse Service of New York and shares its mission of compassion and care for the poor, the chronically ill and elderly. Our guiding principle is to help the most vulnerable among us live safely and independently for as long as possible in their own homes and communities. VNSNY CHOICE has 700 employees, including 227 care management staff. On any given day, VNSNY CHOICE coordinates care for more than 40,000 members through its array of Medicare and Medicaid health plans, including Medicaid Long Term Care, Medicare Advantage, and a HIV/Special Needs Plan. With offices in Manhattan, Brooklyn and upstate New York, VNSNY CHOICE health plans are available in the New York City metropolitan area as well as on a plan basis in selected counties throughout New York State.
RESPONSIBILITIES AND QUALIFICATIONS:
Develops, implements and oversees cost-effective, quality focused services that meet or exceed all regulatory and corporate standards for VNSNY CHOICE Health Plans. Ensures regulatory compliance in all aspects of clinical operations including medical management, utilization management, and UAS assessments for all product lines. Provides leadership in the development and oversight of plan-wide initiatives that form the basis for continuous improvement and customer satisfaction.
Education: Bachelor's Degree in Business or a related discipline or the equivalent work experience required.
Experience: Minimum ten years Utilization Management experience in managed care/HMO required. Minimum five years managerial experience required. Experience with State and external accreditation managed care audits and reviews required. Experience with writing and implementing program level policy and procedures required. Proficient with computer and software programs (e.g.; Microsoft Word, Excel) and the Internet required. Experience applying medical management treatment guidelines, such as InterQual / McKesson, Milliman, or other practical management guidelines required.
VNSNY is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, national origin, disability or protected veteran status. If you would like more information about your EEO rights, then please visit: