Senior Vice President Clinical & Provider Management—Pennsylvania

The French Group has been retained by an award-winning health plan to identify talent for this newly-created role. Reporting to the CEO, the SVP will be responsible for all aspects of clinical and provider services to include clinical management, quality, provider contracting, provider service and pharmacy.

In addition, the SVP will maintain relationships with Owners, Board of Directors, Community, Customers, Providers, and Members as part of the senior management team. The SVP will oversee the development of clinical strategies, including the development of clinical programs, population health initiatives, standards and policies designed to ensure the quality, outcomes and cost-effectiveness of medical care provided to members. 

Additional responsibilities include:

-Provide leadership, clinical and provider oversight, and guidance to the Corporation to maintain the highest levels of service quality by credentialed providers and their staff; optimize utilization levels, and increase the efficiency and effectiveness of health care service delivery. 

-Provide strategic and operational oversight of contracting, value-based initiatives and network adequacy. -Oversee Medical and Administrative savings initiatives, and provide direction for profitable strategic designs for benefit product offerings. 

-Key participant in Medicare BID development and rate negotiations for Medicaid and CHIP. 

-Develop, oversee and maintain budget

-Participate and help direct legislative initiatives that help achieve corporate goals.

-Develop and maintain collaborative relationships with regulatory agencies such as DPW, DOH, NCQA, CMS, etc. to ensure that all clinical protocols and procedures meet and are consistent with regulatory requirements.

RN or MD/DO preferred.

For additional information and/or confidential consideration, please contact Tricia French RN, BSN