MHS Health is a managed care company that employs more than 150 people in its Milwaukee office. MHS Health is a wholly owned subsidiary of Centene Corporation, a leading multi-line healthcare enterprise offering both core Medicaid and specialty services. MHS Health is licensed by the Wisconsin Office of Insurance. MHS Health has a commitment to improving the health of the community one individual at time through affordable and reliable healthcare plans. Founded as a single health plan in 1984, Centene Corporation (Centene) has established itself as a national leader in the healthcare services field. Today, through a comprehensive portfolio of innovative solutions, it remains deeply committed to delivering results for its stakeholders: state governments, members, providers, uninsured individuals and families, and other healthcare and commercial organizations. Fortune Magazine has ranked Centene Corporation No. 66 in its annual FORTUNE 500 list of largest corporations in the United States, ranked by revenue, up from 124th spot last year. Centene has risen 420 spots since first entering the list in 2010.
The Vice President of Medical Management will lead all aspects of quality and medical management for MHS Health. In this capacity s/he will work with the leadership of MHS Health to establish and implement the care management vision based on the needs of the membership and in support of the company’s strategic plan. The selected candidate will spearhead innovation in care management with a focus on improving the quality of care for our members while being fiscally responsible. This role oversees all aspects of disease and care management, measures and monitors process improvement and outcomes, and ensures the success of care management and education programs. S/he plays a key role in the strategic development of wellness and population health programs and the planning of health services for the organization. Responsible for the collection, integrity, analysis, and reporting of data used in monitoring and evaluating care, the Vice President of Medical Management ensures that members are receiving quality care and service. Serving as an external representative of MHS Health, s/he interacts with key customers, regulatory authorities, and advocate stakeholders. Finally, this individual will ensure program compliance with applicable regulations by reviewing selection criteria, monitoring metrics, and service.
- Bachelor’s degree in Nursing, related field, or equivalent experience.
- MBA preferred.
- Ten or more years of clinical nursing, quality improvement, and management experience in a managed care setting.
- Thorough knowledge of a specialized or technical field such as clinical nursing, managed care, and healthcare administration.
- Thorough skills knowledge of quality improvement practices.
- Working knowledge of medical information systems, medical claims payment process, medical terminology and coding, case management practices, managed care, and Medicaid programs.
- Familiarity of National Committee on Quality Assurance (NCQA) accreditation process and standards.
- Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.