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Senior Vice President of Medical Operations

2 months ago

Fountain Valley, California, United States CLevelCrossing Full time
Position Overview
The Senior Vice President of Medical Operations is responsible for overseeing the daily functions of the Medical Operations Department. This role is essential in ensuring that the department meets its established goals and objectives while aligning with the strategic, operational, and financial targets set forth by the organization's leadership.

Key Responsibilities
- Provide leadership and direction to all Medical Operations staff, establishing the scope of activities related to Referral Management, Inpatient Case Management, Ambulatory Case Management, Disease Management, Regulatory Compliance, and Quality Management.
- Lead and support the Medical Operations team, identifying opportunities for employee development and process enhancements.
- Ensure that all departmental functions are adequately staffed according to industry benchmarks and support Directors in cultivating a positive departmental culture.
- Maintain compliance with State and Federal regulations, legislative mandates, and accreditation standards.
- Collaborate with department Directors to develop, implement, and review Quality Improvement and Utilization Management plans.
- Facilitate departmental meetings and work closely with the Chief Medical Officer (CMO) and Medical Directors on strategic planning initiatives.
- Drive initiatives aimed at improving clinical outcomes and operational efficiency in partnership with the Medical Management team.
- Oversee the management of commercial and senior ACO products, fostering relationships with ACO leaders and coordinating cross-departmental efforts.
- Promote a culture of open communication and collaboration across all levels of the organization.
- Develop and manage the departmental budget in collaboration with the CMO and Finance Department, ensuring adherence to company policies.
- Engage with health plan partners to foster effective working relationships and identify opportunities for joint initiatives.

Qualifications
- Bachelor's degree in Nursing or a related healthcare field; a Master's degree in Business Administration or a healthcare-related field is preferred.
- A minimum of 10 years of experience in medical management, with at least 5-7 years in a leadership role within an IPA or medical group.
- Strong knowledge of Federal and State healthcare regulations and accreditation requirements.
- Proven leadership, organizational, and communication skills, with a strong background in strategic planning and financial analysis.
- Familiarity with HIPAA regulations and a commitment to maintaining confidentiality and ethical standards.