Vice President Health Services

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AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii's third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.
The Culture: AlohaCare employees share a passion for helping Hawaii's most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.
AlohaCare's leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii's families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare's comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.
These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.
The Opportunity: The Vice President of Health Services ("VP HS") is a key participant on the Executive Council with primary responsibility for the strategic and operational oversight of Clinical Services. It consists of Health Coordination, Behavioral Health, and Medical Management. The VP Health Services is accountable for improving the effectiveness, efficiency and productivity of each department. Priorities include oversight and intervention of medical expenses like hospitalization, ER, and specialty services that impact the Medical Loss Ratio (MLR). Engagement of members such as high-risk individuals is high priority. The VP HS fosters and exemplifies teamwork and cross-departmental collaboration, coordination, and communication. In this role, the VP HS develops and mentors their direct reports to fulfill their leadership potential. The position requires a leader who possesses the ability to form partnerships with providers, public and social agencies, other health plans, and MedQUEST. While this position ensures contractual and regulatory compliance, they also promote innovation, creative problem solving, diversity of ideas, and health equity.
Primary Duties and Responsibilities: Oversees Medical Management, Health Coordination, LTSS (Long Term Services and Supports), Health and Wellness and Behavioral Health in accordance with AlohaCare's goals and objectives, Medicaid and Medicare Model of Care, and the requirements of MedQUEST, CMS and NCQA.Develops and implements a strategy for the health services departments and programs as part of an organizational wide strategy including business expansions or restructuring.Establishes departmental dashboards, measurable objectives, processes, and integrative workflows.Ensures action plans are developed to reverse unfavorable trends and quickly resolve internal and external audit findings.Approves and oversees the budgets of the individual health service departments, as well as monitors and responds to budget variances with the director(s);Has responsibility for trend management and cost avoidance, working with the directors on interventions to manage to MLR goals.Oversees administrative budget for assigned areas including approve/deny expense reports & requisition requests for department members.Oversees employee-related issues including recruitment, hiring, underperformance, and other issues of Human Resources.Partners with Health Services executives, functional managers and providers/ PCP offices on Quality Improvement and HEDIS/STARS metrics initiatives.Serves as clinical services liaison with inpatient facilities, community health centers and joint operating committees of vendors employed or delegated to maintain positive relationships, problem solve, and ensure adherence to contracts promoting clinical services and quality outcomes.Oversees Utilization Management toward an effective concurrent review process and case management across the continuum of hospital and post-acute providers such as acute rehabilitation, Skilled Nursing Facilities, home health, and outpatient services – consistent with AlohaCare's Medicare Model of Care;Participates in organizational-wide quality and NCQA activities.Guides medical policy strategies, involving proprietary utilization tools, electronic submission of prior authorization requests, analytics for over-and underutilization.Provides oversight and direction for the implementation of clinical service programs, internal operational strategies and initiatives, as well as making data driven decisions to develop and implement market strategies.Is proactive in nurturing relationships with Community Health Centers, Independent Practice Associations, strategic private practice groups, and employed provider groups.Mentors direct reports and carries out individualized plans for their development as leaders with strong people and management skills.Responsible to maintain AlohaCare's confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.Required Qualifications: Nurse (RN, APRN, NP), Psychologist (PhD or PsyD) or related licensed clinicianBachelor's degree in public health or health administration, nursing, social work, or a related field (Masters preferred).Minimum of 8 years of work experience in health services with the majority of time spent in executive leadership roleMinimum of 5 years in Medicaid and/or Medicare programsMinimum of 3 years in managed care and/or care managementClinical program development and implementation experienceMaintenance of health care license (RN, LCSW, LMFT, etc.)Required Skills: Health services toolset development, program development and implementation experienceDirect experience managing and overseeing health services operationsLeading projects and initiatives cross-functionallyCost of care and budget accountability (MLR, P+L, SG&A)Demonstrated track record of participation in audits and compliance programsWorking knowledge of State and Federal policy initiatives that relate to health servicesAbility to thrive in a matrixed environment.Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehabMust be passionate about contributing to an organization focused on continuously improving consumer experiencesAbility to lead meetings and deliver professional presentationsStrong written and verbal communication and presentation skillsPrior success utilizing technology to oversee health teams including using technology to monitor utilization trends and implement cost initiativesDemonstrable use of tools such as Microsoft Office SuiteMental, Physical and Environmental Demands: Travel is required between the Hawaiian Islands for member, provider, and staff interactions.Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.Inside working conditionsRequires operation of general office equipment to include PCSalary Range: $150,000 - $200,000 annually
AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans' status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.

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