Associate Vice President, Utilization and Care Management Job at Altais Health S

About Our Company

At Altais, we’re looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. At Altais, we’re building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve. Altais family of companies include Brown & Toland Physicians, Family Care Specialists and Altais Medical Groups.

About Your Team

Are you looking to work with a high performing, fast growing and dynamic Healthcare Management team? We are 4,000+ physicians, working in over 40 cities throughout California, caring for more than 500,000 patients. If you are passionate about reshaping healthcare and want to work for a mission driven organization where new ideas and innovation are valued, then we would like to meet you.

About Your Work

The Associate Vice President of Utilization Management & Care Management is responsible for clinical and operational oversight and leadership of utilization management, care management and vendor management programs that drive cost of healthcare improvement across multiple lines of businesses for BSC and other payors. The AVP of operations will report into the President of Altais Health Value. This leader will be responsible for design, development, operational planning, operational improvement and overall governance and performance of UM/CM programs and initiatives across multiple departments in alignment with Altais’ long-term mission and vision to bend the total cost of care. In partnership with executive leaders, clinicians, operations, finance, IT, shared services and payor clients, this role will bring strong rigor around leadership, culture development, change management, relationship management, performance management and day to day execution of Altais programs. This role serves as a key stakeholder, decision enabler, and catalyst, for all market level medical cost management, strategy, evaluation, monitoring and reporting to achieve the Quadruple Aim.

This role requires travel to our Oakland Headquarters on a regular basis.

You Will Focus On:

Strategy:

• Lead development of UM/CM strategy, staffing, data/analytics and recommended technology solutions to streamline operations.
• Collaborate with senior leadership to define and implement the organization's operational strategy.
• Analyze market trends and operational performance to identify opportunities for improvement and drive rigorous management process for performance.
• Evaluate and understand drivers impacting various segment of total cost of care for populations across different lines of businesses including HMO and PPO products. Develop strategies to effectively manage and/or reduce the cost of care for all lines of business while maintaining high quality of care for patients.
• Monitors significant utilization trends, patterns, and drives strategic resource deployment to impact unnecessary utilization trends.
• Drive NCQA/URAC accredited UM/CM and med management programs serving multiple lines of businesses.
• Analyze, interpret and apply healthcare utilization data to systematically explore and identify opportunities to improve total cost of care and then deploy programs to create meaningful outcomes.
• Experienced clinical understanding of inpatient and outpatient care delivery to be able to assess appropriate utilization and reduce low value care.

Operations:

• Develop field based, virtual, onshore and offshore medical cost management programs that help contain inpatient and institutional cost of care.
• Understand unique community health needs and the attributes of the populations served to drive development of programs and services.
• Develop Key performance measures to manage ROI of UM/CM programs and drive execution across a wide geography of patient population.
• Develop programmatic performance, policies, procedures, and systematic workflows and to achieve high quality certification of programs including NCQA and URAC certifications.
• Uses analytics to identify key insights about the populations served and drive the development of the interventions to target unique populations.
• Oversees performance of all inpatient care management, health navigation, care gap closure, post discharge coordination, CM and UM programs as per contractual guidelines. Develops risk management and mitigation plans as necessary to ensure high quality and high performance clinical programmatic delivery.
• Liaises with state regulators for clinical programs.
• Coordinates quality initiatives (audits, contract reviews, etc) and drives management of enterprise and local policies.
• Informs and executes against contracts (including provider contracts) – driving outcomes captured in contract and operationalizing locally.
• Executes on standards and customizing per local requirements while partnering with the COEs to drive continuous improvement through governance and performance monitoring.
• Drive clinical understanding of inpatient and outpatient care delivery to assess appropriate utilization and reduce low value care.
• Conducts and/or supports quality improvement and outcomes studies related to utilization management.
• Monitors member and provider satisfaction survey results with the utilization management process and suggests changes as needed to increase satisfaction and assure that satisfactory relationships are maintained.
• Oversee UM/CM teams with direct responsibility to hire, coach, performance manage leaders and team members across all functional areas of medical management programs.
• Oversee operational budget of all relevant programs.

Cross-Functional Leadership:

• Collaborate across multiple functions to develop a high performing operating model that creates seamless experience for our clients as well as patients.
• Ensure compliance with company policies and procedures, as well as local, state and federal requirements.
• Interacts with medical staff and other team members to develop a clinical quality improvement plan that links with the strategic goals of the organization.

Performance Monitoring and Management:

• Establish key performance indicators (KPIs) to measure operational success for all applicable programs and drive mitigation in areas of risk of underperformance.
• Regularly review, monitor and report on operational performance, providing actionable insights to leadership.
• Drive insightful JOCs and operational meetings to ensure performance alignment across all areas.

Change Management:

• Lead organizational culture and change in alignment with mission and vision of Altais.
• Foster a culture of continuous improvement, accountability, performance, collaboration and adaptability within the organization.

Stakeholder Engagement:

• Communicate effectively with stakeholders at all levels to ensure buy-in for operational strategies.
• Build strong relationships with internal and external partners to support strategic initiatives.

The Skills, Experience & Education You Bring

• Bachelor of Science in Nursing or clinical field required
• Master's degree or equivalent experience preferred
• Minimum of 7 years prior relevant experience, including 3-5 years of management experience
• Health plan or similar health care organization structure experience required

You Share our Mission & Values

• You are passionate about improving the healthcare experience and want to be part of the Altais mission.
• You are bold and curious – willing to take risks, try new things and be creative.
• You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard.
• You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing.
• You co-create, knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective.
• You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency.

Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, and experience.

Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.

Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of workday.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.