Associate Vice President, Utilization and Care Management

$196,816 - $278,986/Yr

Altais Health Solutions - Oakland, CA

Full-time - Senior

Remote - Oakland, CA

1,001-5,000 employees

About the position

The Associate Vice President of Utilization Management & Care Management at Altais Health Solutions is responsible for overseeing clinical and operational aspects of utilization management and care management programs. This role involves strategic planning, operational improvement, and governance of programs aimed at reducing healthcare costs while maintaining high-quality care. The AVP will collaborate with various stakeholders, including executive leaders and clinicians, to drive performance and achieve organizational goals.

Responsibilities

• Lead development of UM/CM strategy and operational planning.
• Collaborate with senior leadership to define and implement operational strategy.
• Analyze market trends and operational performance to identify improvement opportunities.
• Develop strategies to manage and reduce the cost of care while maintaining quality.
• Monitor utilization trends and drive resource deployment to impact unnecessary utilization.
• Drive NCQA/URAC accredited UM/CM programs across multiple lines of business.
• Analyze healthcare utilization data to identify opportunities for improvement.
• Develop field-based and virtual medical cost management programs.
• Establish key performance measures to manage ROI of UM/CM programs.
• Oversee performance of inpatient care management and health navigation programs.
• Develop risk management and mitigation plans for clinical program delivery.
• Coordinate quality initiatives and manage enterprise and local policies.
• Conduct quality improvement studies related to utilization management.
• Monitor member and provider satisfaction with the utilization management process.
• Oversee UM/CM teams, including hiring and performance management.
• Manage operational budget for relevant programs.
• Collaborate across functions to develop a high-performing operating model.
• Establish KPIs to measure operational success and drive performance alignment.

Requirements

• 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.
• Experience in a health plan or similar healthcare organization structure required.

Nice-to-haves

• Experience with NCQA and URAC certifications.
• Strong analytical skills and experience with data-driven decision making.
• Proven ability to lead change management initiatives.

Benefits

• Work from home options
• Competitive compensation package
• Robust benefits program