Vice President, Health Services

Community Health Plan of Washington (CHPW) has an opportunity for a Vice President, Health Services who provides vision and leadership to advance CHPW utilization and care management programs to meet the needs of the populations served in a manner that optimizes use of community resources. Provides strategic direction, leadership and oversight for fully integrated Medical Management Operations programs including: Utilization Management (UM), Population Health Management (PHM), Complex Case Management (CM), Transitions of Care (TOC) and Care Coordination and Community Linkages (CCCL). In addition, this position will strategically drive expansion of community-based programs by closely aligning CHPW with community-based clinics to integrate processes and programs with local resources.

At Community Health Plan of Washington, we believe that each of us shares a responsibility in helping others.

We are looking for:

Education/Licensure:
· Bachelor’s degree in Nursing or other relevant field required; OR equivalent combination of education (Nurse Practitioner, Physician Assistant, Medical Doctor) and highly relevant experience required.
· Master’s degree in Healthcare, Business Administration, or highly relevant work experience beyond minimum requirements may be substituted for Master’s degree. Advanced degree (MBA, MHA, MPH) preferred.
· Certificate or degree in analytics or information systems preferred.
· Current, unrestricted license in any US State as an RN, ARNP, PA, or MD required; ability to obtain a Washington license within 90 days of hire.
· As this position involves traveling on behalf of the Company, a current driver’s license and an acceptable driving record is required.

Work Experience:
· Experience designing, building and deploying programs, as well as on-going management.
· Ten (10) years of progressively responsible management-level experience in a health plan, preferably Medicaid or Medicare managed care, overseeing medical management programs required.
· Expertise with analyzing productivity data and claims data.
· Experience with health plan quality improvement programs.
· Experience developing and managing social determinant of health programs
· Familiarity with Medicaid and Medicare populations required.
· Ten (10) years of clinical nursing and management experience in a managed care setting.
· Minimum of Five (5) years of experience directing medical utilization management, population health and complex case management functions.
· Management and team leadership experience within a health plan or health organization.
· Population health program experience, i.e. identifying and stratifying populations for differing interventions and strategies.
· Experience with social determinants of care, behavioral health and community based services as part of an integrated model.
· Experience working with and using clinical data effectively to improve efficiency and effectiveness of care.
· Experience with planning, implementing, and evaluating clinical and disease prevention programs.
· Experience with National Committee on Quality Assurance (NCQA) accreditation process and standards.
· Familiarity with programmatic and clinical research strategies in a managed care setting preferred.
· Working knowledge of medical information systems and medical claims payment process.

We offer:

· Full medical, dental and vision benefits
· Community Service Hours
· Paid Time Off and Holiday Pay
· Tuition Reimbursement
· Transportation perks as a portion of our comprehensive and competitive benefits program
· Convenient downtown Seattle location near Pike Place Market

Interested? Learn more at chpw.org/careers

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

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