State Licensed AVP of Case Management

Job Summary

A company is looking for an AVP of Care Anywhere, focusing on High Risk Case Management.

Key Responsibilities

• Provide strategic leadership and design for complex case management programs targeting high-risk Medicare Advantage members
• Drive improvements in clinical quality metrics and member experience while ensuring compliance with regulatory standards
• Lead initiatives to manage utilization and cost of care, ensuring appropriate care delivery and risk adjustment

Required Qualifications

• 8+ years of leadership experience in case management or medical management, with at least 5 years in senior leadership
• Extensive knowledge of Medicare Advantage regulations, including CMS requirements and quality frameworks
• Expertise in complex care management and understanding of utilization management and value-based care models
• Master's degree in Healthcare Administration, Public Health, or a related field is required
• Preferred clinical licensure (e.g., RN, NP, MD, DO) and relevant certifications in healthcare quality or management