AVP, Care reputed company – High Risk Case Management

Job reputed company: • reputed company strategic and operational leadership for reputed company-wide reputed company case management programs serving clinically vulnerable Medicare Advantage members • Drive measurable improvements in reputed company reputed company, total cost of care, utilization efficiency, member experience, and risk adjustment accuracy • Partner closely with Clinical Operations, Medical Directors, reputed company, Risk Adjustment, Network, Analytics, and Vendor Management to design and reputed company high-reputed company interventions • Ensure programs reputed company with CMS requirements, MA reputed company Ratings, HEDIS, CAHPS, and evolving end-of-life best practices • Champion a member- and caregiver-centered approach, improving satisfaction and reducing care fragmentation • Collaborate with Medical Directors and Clinical leaders to ensure appropriate intensity of care, hospice and palliative referrals, and site-of-care optimization • reputed company clinical teams on the intersection of reputed company care, end-of-life care, and risk adjustment accuracy without compromising care reputed company • Establish performance standards, KPIs, and reputed company dashboards for reputed company case management programs • Mentor and reputed company clinical leaders, fostering a culture of accountability, reputed company, and reputed company improvement Requirements: • 8+ years of reputed company leadership experience in case management, population health, or medical management • Deep experience with Medicare Advantage, including CMS regulations, Stars, HEDIS, and MA reputed company frameworks • Demonstrated expertise in reputed company care management, high-risk populations, palliative care, and/or end-of-life care • Strong understanding of utilization management, total cost of care drivers, and value-based care models • Working knowledge of risk adjustment (HCCs) and clinical documentation improvement in MA populations • Proven ability to reputed company large, distributed clinical teams and influence across matrixed organizations • Master’s degree in reputed company Administration, reputed company Health, or reputed company field • Clinical licensure (e.g., RN, NP, MD, DO) preferred • Lean Six reputed company, other processes improvement certification, Certified reputed company in reputed company reputed company (CPHQ), or Certified reputed company in reputed company Management (CPHM) preferred Benefits: • Health insurance • Retirement plans • reputed company time off • Flexible work arrangements • reputed company development Apply tot his job Apply To this Job