Description
Title: Staff VP, Behavioral Health Clinical Operations
Preferred Location: New York, Indianapolis, California OR within 50 miles of an Elevance Health Pulse point office.
Summary:
To deliver value to payers, providers, and members by delivering clinically and morally sound utilization management and clinical programs for Behavioral Health. Reporting to the Chief Medical Officer, is accountable for the clinical leadership, strategy, and operational performance of the Utilization Management (UM) and Case Management (CM) departments across all Carelon Behavioral Health.
Duties and Responsibilities include but are not limited to the following:
- Oversees centralized UM & CM functions including external business and internal commercial business across the country.
- Develops and manages strategies to optimize utilization results, provide service performance, and ensure consistency and compliance with the enterprise and state and federal regulations.
- Leads a team that delivers UM & CM operations and is responsive to Carelon Behavioral Health regional leads and stakeholders to ensure tight collaboration between the clinical departments and client-facing teams.
- Will manage a large team across dozens of locations. The teams will be responsible for regional UM & CM, continuous quality improvement, UM & CM infrastructure, analytics, and connectivity with the operations teams for the supporting capabilities the team will require IT, analytics, finance, compliance, etc.
- Accountable for all incoming UM & CM requests, for all prior authorization and continued stay reviews, and for discharge documentation, discharge planning, aftercare, follow-up after hospitalizations. This includes quality and case management programs and the performance of these programs.
- Will ensure that his/her direct reports build strong relationships with the regional and account leads across the company to assure market satisfaction, growth and stabilization when indicated.
- In collaboration with Finance, provide thought leadership and validate UM & CM target-setting for Carelon Behavioral Health Risk and ASO accounts.
- Create & maintain close partnership with Carelon Behavioral Health and Elevance Health regional Market Presidents & stakeholders who have P&L responsibility and will look to clinical management performance as a key driver of the success of the P&L.
- The Staff Vice President, or regional designees, will participate in governance forums to track the overall medical management performance and the P&L of each region.
- Champion a dynamic growth culture by driving revenue, profitability and initiatives aligned with the company’s mission, vision, and values.
- Recruit, develop and retain key talent through coaching, training, and leadership development.
Qualifications:
- Requires BA/BS in a clinical field, such as nursing, social work or psychology and minimum of 15 years progressively responsible management and senior leadership experience in healthcare and managed care industry; or any combination of education and experience, which would provide an equivalent background.
- Current, valid, unrestricted clinical license (RN, LCSW, MFT, LPCC, PhD or PsyD) required or BSN and must practice within scope of licensure.
- Bachelor’s degree in a clinical field, including nursing, social work or psychology is required.
Preferred Skills, Capabilities and Experiences:
- Experience working with Behavioral Health programs within a managed care or similar organization.
- Demonstrated highly effective communication skills in all manners (written, verbal, and presentation).
- Experienced in highly effective and strong leadership skills developing an effective and collaborative team with the agility to address all issues in scope.
- Executive leadership experience in an organization including strategic planning and execution of plans, change management preparation and successful transformation of an organization in anticipation of industry and corporate/organization evolution.
- Master’s degree such as MBA or MPH is in a clinical field is desirable.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $198,000 to $310,000
Locations: California; Colorado; Nevada; New York; Washington State; Jersey City, NJ
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.
Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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 ability@icareerhelp.com for assistance.