Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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AVP, Care Management Operations
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
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.