Sentara Health Plans is recruiting a Vice President, Medicaid Case Management and Utilization Management in Florida! Sentara Care Alliance, a service of Sentara Health Plans, is the visionary leader responsible for the long-term success and sustainable growth of our Florida-based organization providing vital health coverage to Florida's Medicaid beneficiaries.

Provide Leadership and Transformation of Medicaid UM/CM Programs. Continuous improvement in Medicaid clinical performance including readmissions, chronic care utilization and unplanned care through CM outreach and programs. Adherence to each state’s Medicaid contract UM/CM requirements. Coordination with Medicare UM/CM to ensure seamless care and management of DSNP aligned members. Collaboration and Partnership with ICMs, SMG and SQCN/SACO to create a differentiated experience for shared patients. Support Medicaid growth through RFP responses, new plan builds and new program creation.

-Drive performance in outcomes and build new programs in Population Health and Disease Management
-Work with CM teams to identify and address opportunities in sub-populations for program development
-Identify opportunities for linkage and coordination between Ambulatory, Hospital and CIN divisions across the care continuum 
-Partner with VBC Leadership to support provider performance in new payment models
-Support programs designed to improve performance on HEDIS, STARs and efficiency measures 
-Create linkages with, quality, pharmacy, palliative care, and community impact in the development of programs
-Identify opportunities for improvement in outcomes, cost of care and member experience; Identify opportunities for enhanced collaboration across the care continuum and the creation of a differentiated experience for shared patients
-Develop and implement training programs for clinical teams 
-Ensure adherence to regulatory, compliance and accreditation rules and directives

8-10 years Progressive Leadership Experience in UM/CM leadership in a health plan with proven outcomes in utilization management, member engagement, chronic disease management and reductions in unplanned care
Experience in matrixed leadership structure 
Demonstrated ability to build cross-functional programs…
5 years Direct Health Plan UM/CM experience in Medicaid

#LI-AR1

• Case Managment - Certification - Other/National
• Utilization Management - Certification - Other/National
• Registered Nurse License (RN) - Nursing License - Compact/Multi-State License
• Medical Doctor (MD) - Certification - Other/National

• Doctor of Medicine
• Master's Level Degree
• Master's Level Degree

• Leadership 8 years
• WORK EXPERIENCE RATING-3-13728