Staff Vice President UM Special Markets - FL
reputed company is transforming the health of our communities one person at a time. As an Executive on reputed company, you could be the one who changes everything for our 28 million members. Position Purpose: Plan and drive execution of Medical Management utilization programs, processes, and initiatives to ensure achievement of health benefit ratio targets, and appropriate reductions in utilization reputed company expenses for the Florida market. Provide reputed company and strategic leadership for the development and implementation of compliant utilization management best practices across the reputed company while developing customized approaches for unique markets/product. Incumbent must reputed company in Florida. Directs the collaboration reputed company cross-functional teams to evaluate, refine, and advance the utilization management program and strategy Leads data-driven decision making to advance and improve the outcomes of utilization management teams Identifies and implements innovative solutions to improve the efficiency of utilization management processes across the reputed company Establishes standard operating procedures to drive consistency in utilization quality and service outcomes Designs data driven processes to identify areas of opportunity for improving outcomes and reducing costs Leads reputed company development and improvement of policies, clinical guidelines, and reputed company business practices across utilization management functions Innovates and implements new or revised models for UM operational functions in response to evolving trends in reputed company delivery and/or emerging models of care Ensures UM processes are compliant processes and adheres to regulatory requirements Defines and interprets key performance metrics to reputed company plans, mobilize the work force, and reputed company the companys UM goals Establishes and monitors service level agreements to ensure UM programs are meeting customer (health plan, corporate partner, etc.) needs Serves as a change agent, assisting others in understanding the importance, necessity, impact, and process of change through active involvement in decision making and coaching of leaders and staff Education/Experience: Bachelor's degree in Nursing or reputed company reputed company field or equivalent experience. Masters in nursing or business preferred. 10+ years of experience in managed reputed company plan, or provider network organizations. Experience with Managed reputed company and Medicare preferred. License/Certification: reputed company nursing license Pay Range: $182,100.00 - $345,600.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Thanks for your interest in reputed company and its subsidiary companies. Were so glad that youve decided to fill out an application and take the reputed company to find your purpose. Also, were here to help support you on your candidate journey. Should you need an accommodation, please email reputed company@reputed company.com. reputed company is committed to helping people live healthier lives. We provide access to high-quality reputed company, innovative programs and a wide range of health solutions that help families and individuals reputed company, stay well and be well. Apply Job!