The Vice President of Medical Management will lead all aspects of quality and medical management for MHS Health. In this capacity s/he will work with the leadership of MHS Health to establish and implement the care management vision based on the needs of the membership and in support of, the company’s strategic plan. The selected candidate will spearhead innovation in care management with a focus on improving the quality of care for our members while being fiscally responsible.
This role oversees all aspects of disease and care management, measures and monitors process improvement and outcomes, and ensures the success of care management and education programs. S/he plays a key role in the strategic development of wellness and population health programs and the planning of health services for the organization. Responsible for the collection, integrity, analysis, and reporting of data used in monitoring and evaluating care, the Vice President of Medical Management ensures that members are receiving quality care and service. Serving as an external representative of MHS Health, s/he interacts with key customers, regulatory authorities, and advocate stakeholders. Finally, this individual will ensure program compliance with applicable regulations by reviewing selection criteria, monitoring metrics, and service.
MHS Health is a managed care company that employs more than 150 people in its Milwaukee office. MHS Health is a wholly owned subsidiary of Centene Corporation, a leading multi-line healthcare enterprise offering both core Medicaid and specialty services.
•Bachelor's degree in Nursing, related field, or equivalent experience. •MBA preferred. •Ten or more years of clinical nursing, quality improvement, and management experience in a managed care setting. •Thorough knowledge of a specialized or technical field such as clinical nursing, managed care, and healthcare administration. •Thorough skills knowledge of quality improvement practices. •Working knowledge of medical information systems, medical claims payment process, medical terminology and coding, case management practices, managed care, and Medicaid programs. •Familiarity of National Committee on Quality Assurance (NCQA) accreditation process and standards. •Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.