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.

VP, Clinical Services

📁
Vice President
📅
4492BR Requisition #
Sign Up for Job Alerts
Summary:
  • Works with CMO to develop a cohesive enterprise-wide vision for delivery of quality, cost-effective care, ensuring compliance with all applicable government regulations and health care agency standards, and actively supports and coordinates enterprise corrective action plans.
  • Provides oversight and direction to care management policy and program development and implementation, ensuring that they comply with organization’s own medical policies, deliver quality care, are financially sound business practices and that day to day clinical decisions are consistent with these policies.  
  • Provides leadership and guidance with medical policy and benefit decision making processes; new technology assessment decisions; and assessment of new internally developed programs as well as those developed externally through strategic partnerships and vendors. 
  • Supports other areas in implementing cross-departmental changes.   
  • Works with others on the clinical team in the development of Evidence-Based Medical Practice Guidelines to provide industry standard uniform treatment criteria and protocols, in the effective and efficient delivery of care.
  • Manages the clinical audit team and oversee the clinical vendor management relationships.
  • Works with others in the evaluation of new and emerging technologies and treatments to determine possible incorporation into enterprise care management programs.  Evidence-Based protocols and medical policies will be developed for each new care item.
  • Works with the Clinical Services leaders on medical education and clinical development to Plan staff.
Responsibilities:
  • Makes significant contributions towards EmblemHealth’s short and long term business initiatives which include Operating Income, Administrative Expenses, Medicare & Medicaid ratings, and Net Promoter Score performance.
  • Identifies, hires, and trains staff members, developing them into strong leaders and creating high-performing, self-directed teams.  Effectively works toward succession planning ensuring talent pipeline.
  • Acts as change agent to drive and effect organizational change ensuring key deliverables are met.

Qualifications:
  • Bachelor’s degree in Nursing
  • New York State RN Licensure
  • 10 years of healthcare experience including some years in a leadership role
  • 5 years of managed care/insurance experience including some years in a leadership role
  • Knowledge of regulations and coverage policy relating to Medicare and Medicaid
  • Knowledge and understanding of regulations and best practices related to Care Management
  • Analytics knowledge required
  • Experience with Microsoft Office (Access, Excel, Outlook, PowerPoint and Word) required


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.

Previous Job Searches

Please try again.

Oops!

Either there was a problem on our end with the action you just performed, or we are currently having technical difficulties with our system. Please try again later.