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VP, Market Leader - Commercial Health Plan, Behavioral Health

Minor Outlying Islands, USA | Magellan Health

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
    Biotech/R&D/Science
  • Experience:
    10-12 years
Job Description:
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This position leads the commercial member market as the subject matter expert and strategic visionary of Behavioral Health clinical care management for commercial market members. Serves as the central point of contact to stakeholders for acquisition and retention of key contracts and business. Supports the organization’s ability to acquire, build and manage customer relationships on products and services. Responsible for the, oversight, maintenance and growth of business line, and is responsible for setting a business plan that informs the company’s go to market strategy and works with service areas to understand market requirements and ability to deliver services. Liaisons with key business partners in the Sales organization, Strategy, Shared Service Operations, Clinical Center of Operational Excellence, Clinical Centers of Excellence, and the Medical Director. Responsible for achieving business objectives and goals, helping to cultivate and foster relationships with current and new customers in the commercial market, and collaborating with other service areas of the organization to confirm effective delivery of services.

Sets and executes strategic vision and objectives for the commercial market using market analysis and industry trends.

Develops and implements long-term strategic initiatives focused on achieving operational excellence in the commercial market.

Collaborates with Behavioral Health Medical, Clinical and Shared Service Operations to effectively communicate capabilities and solutions to new and potential commercial customers to ensure ability to administer services effectively.

Develops workplans in conjunction with the sales and marketing team to foster and grow current customer relations and to develop new customer relations; define commercial market approach.

Ensures contract requirements are understood, communicated and met; deliverables are accurate and delivered in a timely manner; participate in rate setting discussions.

Designs, develops, and implements programs in commercial market focused on improving effectiveness, affordability, and quality of care.

Oversees performance of Engagement and Care Management teams in a matrix reporting relationship alongside the Center of Operational Excellence Leads.

Assumes responsibility for growth, revenues, cost of care, operating gain, quality results and operational efficiency and effectiveness.

Consults with clinical stakeholders to develop improved utilization of effective and appropriate services, including effective member engagement strategies.

Collaborates with Care Management Operations, Engagement Operations, Routine and Complex Care Management and Transition of Care Whole Health Managers to ensure operational goals are aligned to Whole Health’s strategic plan and vision

Develops and implements action plans to improve performance and department outcomes, manage medical cost trends, and provide leadership periodic updates.

Provides leadership and expertise representing Whole Health in new business activities (RFP responses, new market/product development, etc.) and upsell and cross-sell opportunities with existing clients.

Collaborates on the development & implementation of a staff plan, including learning and development strategy, in collaboration with the relevant Magellan leaders.

Anticipates and acts on emerging healthcare trends to position the Whole Health line of business for the future, in conjunction with other Magellan leaders.

Communicate clearly and persuasively to build support for initiatives, engaging Magellan stakeholders and other relevant system stakeholders.


Other Job Requirements


Responsibilities


10+ years of experience in healthcare with a clinical and/or operations management focus.

10+ years of management level experience in the managed healthcare industry required.

Knowledge of managed healthcare delivery systems to include critical components and interdependencies.

Knowledge of the variety of financial and clinical structures viable in the managed care arena.

Knowledge of clinical issues unique to the delivery of mental health and substance abuse services, of strategic planning

and the budget process.

Ability to communicate and advocate at the line through corporate staff levels.

Must possess strong analytical and organizational skills in a multiple site and function environment.

Proven ability to manage operations in a clinical healthcare system.

Strong negotiating and contracting skills.

10 or more years of experience in professional practice

7 years post-degree (masters/doctoral) experience in behavioral health

7 years working with commercially insured populations

Significant experience managing commercially insured clinical operations


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