Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.
CareMore is a proven care delivery model for the highest risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in the total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources of one of America’s largest managed healthcare organizations.
Title: Staff Vice President, MSO (Management Services Organization)
Location: This position will work in a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
Reports to the National Chief Medical Officer for CareMore & Aspire Health
What Is CareMore?
CareMore is entering a new growth phase, as a proven care delivery model for the highest risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients and currently serve nearly 150,000 patients in most states across Medicare, Medicaid, and commercial populations. We strive for excellence and have achieved significant and measurable improvement in the total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources of one of America’s largest managed healthcare organizations.
CareMore’s Health Networks, Primary Care+, Touch, and CareMore@Home models drive strategy, operations, and care delivery in our national markets. Our comprehensive, upstream approach to health is led by robust multidisciplinary teams of extensivists (managing acute and post-acute episodes of care), primary care clinicians, behavioral health clinicians, care management & engagement specialists (including social workers, case managers, and community health workers), virtual care providers, and mobile home-based care teams. We continue to evolve our model to effectively engage and care for complex patients, led by a team of passionate, execution-minded leaders dedicated to this mission.
Responsible for the administration of medical services for company health plans.
Primary duties may include, but are not limited to:
Manages medical performance for an assigned health services area.
Interprets existing policies and develops new policies based on changes in the healthcare or medical arena.
Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
Supports the Medical Management staff ensuring timely and consistent responses to members and providers.
Identifies and develops opportunities for innovation to increase effectiveness and quality.
Serves as a resource and consultant to other areas of the company as needed.
May chair or serve on company committees and represent the company to external entities and/or serves on external committees, and provides guidance for clinical operational aspects of the program.
Supports and adheres to and applies SMC, Federal, State, and National Standard criteria to medical decision-making.
Hires, trains, coaches, counsels, and evaluates the performance of direct reports and directly supervises the management of any assigned staff (approx ~250 FTEs).
Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). Must possess an active unrestricted medical license to practice medicine or a health profession. Minimum of 10 years of clinical experience or any combination of education and experience, which would provide an equivalent background. For URAC-accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Preferred Skills, Capabilities, and Experiences:
Experience working with providers as business partners for a managed care or health plan organization
Experience managing a team of Utilization Management/Case Management direct reports (MDs)
Experience with STARS, HEDIS, and Quality scores
Experience working with Pharmacy and administration of Part B benefits
MBA strongly preferred
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $297,040 to $445,560.
Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.