The Vice President, Care Management is a senior clinical and operational leader responsible for the strategy, performance, and oversight of enterprise-wide outpatient care management and social work programs across multiple markets. This role provides leadership for integrated, clinic-based models serving complex and high-risk populations, with a strong focus on value-based care, Medicare Advantage, and whole-person care delivery.
This position directs programs including complex case management, chronic disease management, behavioral health integration, and social work, ensuring a coordinated approach that addresses social determinants of health and leverages community-based interventions.
In collaboration with operational leaders, the VP is accountable for program performance, alignment with organizational priorities, and execution of care management strategies. The role ensures compliance with evidence-based clinical guidelines and all applicable regulatory and accreditation requirements, including Medicare and NCQA standards. Additionally, the VP provides long-term strategic planning to integrate care management programs into the organization's broader mission, operational goals, and commitment to high-quality, patient-centered care
The VP of Care Management works closely with the WellMed Leadership and operational teams to achieve the goals and objectives of the Care Management Program and to execute strategy through a matrix model across operations, affordability and clinical leadership.
Primary Responsibilities:Care Management Programs: Basic and Complex Care Management, Transitions of Care, and Social Work
- Designs and directs Care Management and Social Work program descriptions, work plans, program evaluations and overall Model of Care using best available literature and evidence
- Directs the development, planning and execution of continual process improvement efforts, policies, procedures, and regulatory compliance functions related to care management and social work activities
- Collaborates with physician leadership to execute the implementation of the care management programs as defined by Enterprise as well as OptumCare. Provides information/data to market leadership on an ongoing, regular cadence approved by leadership
- Promotes understanding, communication and coordination of all care management programs components with regions and their leadership
- Provides oversight and coordination for all activities related to delegated and regulatory requirements including annual health plan delegation audits as needed
- Drives adoption of best practices and trends for CM and SW activities
- Participates in health plan CMS audits as needed
- Monitors/analyzes metrics/data/trends and ensures areas needing attention are communicated to applicable stakeholders and action plans are put into place
- Develops operating budget as necessary and participates on various teams, committees and meetings at WellMed and OptumCare
- Designs and directs configuration for CM/DM and SW core application and documentation system
- Drives and assists in the design of strategic plans and management of enterprise-wide, large-scale clinical initiatives, pilots, and projects promoting quality care for seniors
- Directs and oversees innovation initiatives, data analysis activities, and evaluation strategies for clinical programs including, but not limited to, pilot projects, grant-funded research projects, and publication endeavors related to the population we serve in multiple markets and based on the latest evidence
You9ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- Registered Nurse (RN) degree with minimum of 10 years experience in practice; Active and unrestricted license to practice in any US state with the ability to obtain a Texas license within 12 months of starting employment required
- 10+ years of management-level experience in managed care, medical management programs required, including five or more years of experience at the Director level or above. Ability to manage up, laterally, and within non-traditional matrix structures by influence
- Knowledge of fiscal management and human resource management techniques; proven evaluative and analytical skills; ability to analyze data/reports and make recommendations
- Demonstrate knowledge of the business environment and business requirements (e.g., strategy changes, emerging business needs)
- Knowledge of federal and state laws and NCQA regulations relating to managed care, and all aspects of Medical Management
- Proven capability working with people at multiple levels organization, prefer multiple locations, multi-function
- Proven excellent training and collaboration skills; excellent verbal, written communication, presentation, and facilitation skills; presentation SME with market level interface
- Proven ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public
- Proven exceptional organizational, detail and accuracy skills
- Proven ability and willingness to travel both locally and non-locally as determined by business need
- Ability to travel up to 30% of the time
Preferred Qualification:- Master9s degree in Healthcare or Business Administration preferred (10 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a Master9s degree). Demonstrate knowledge of the business environment and business requirements (e.g., strategy changes, emerging business needs)
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you9ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $134,600 - $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.
