Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

AVP, Care Management Operations

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Director and Equivalent
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200NN Requisition #
Thanks for your interest in the AVP, Care Management Operations position. Unfortunately this position has been closed but you can search our 155 open jobs by clicking here.

Qualifications:

  • BSN, RN preferred.
  • Master’s in Health Care Management or Administration preferred.
  • 12 - 15 years of managed care experience required.
  • Progressive management experience required.
  • Industry level knowledge and understanding of regulations and best practices related to Care Management and Utilization Management required.
  • Working knowledge of regulations and coverage policy relating to an insureds’ benefits preferred
  • Experience in the development and implementation of analytics and metrics to measure programs’ success and evaluate for improvements to meet and exceed established goals for care delivery.
  • 10+ years of managed care leadership experience required
  • 6-10 years of leadership experience with increasing responsibility required
  • Health care administration preferred
  • Knowledge of NCQA, JCAHO and American Accreditation HealthCare Commission/URAC standards required
  • Knowledge of HEDIS and STARS requirements. Strong organizational skills
  • Excellent written, oral communication skills, including facilitation and presentation skills
  • Ability to work well in groups and independently
  • Knowledge of regulatory and accreditation requirements
  • Excellent conflict resolution skills
  • Proven track record for leading a progressive, efficient and cohesive medical management programs
  • Exceptional team building skills and proven ability to drive operational improvements through high-performing work teams
  • Thought leader with excellent negotiation, decision-making, and analytic skills
  • Excellent interpersonal, organizational, and leadership skills with the ability to coach, mentor and inspire staff to excel

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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