VP, Medical Management

Overview

As the largest and leading value-based kidney care company, Somatus is empowering patients across the country living with chronic kidney disease to experience more days out of the hospital and healthier at home.

It takes a village of passionate and tenacious innovators to revolutionize an industry and support individuals living with a chronic disease to fulfill our purpose of creating More Lives, Better Lived. Does this sound like you?

Showing Up Somatus Strong

We Foster An Inclusive Work Environment That Promotes Collaboration And Innovation At Every Level. Our Values Bring Our Mission To Life And Serve As The DNA For Every Decision We Make

• Authenticity: We believe in real dialogue. In any interaction, with patients, partners, vendors, or our teammates, we are true to who we are, say what we mean, and mean what we say.
• Collaboration: We appreciate what every person at Somatus brings to the table and believe that together we can do and achieve more.
• Empowerment: We make sure every voice gets heard and all ideas are considered, especially when it comes to our patients’ lives or our partners’ best interests.
• Innovation: We relentlessly look for ways to improve upon the status quo to continuously deliver new solutions.
• Tenacity: We see challenges as opportunities for growth and improvement — especially when new solutions will make a difference for our patients and partners.
  
  

Showing Up for You

We Offer More Than 25 Health, Growth, And Wealth Work Perks To Help Teammates Learn, Grow, And Be The Best Version Of Themselves, Including

• Subsidized, personal healthcare coverage (medical, dental vision)
• Flexible Paid Time Off (PTO)
• Professional Development, CEU, and Tuition Reimbursement
• Curated Wellness Benefits supporting teammates physical and mental well-being
• Community engagement opportunities
• And more!
  
  

The Vice President of Medical Management, under direction of the Deputy Chief Medical Officer, is responsible for providing executive clinical leadership to direct and advance enterprise-wide efforts to improve measurable value (quality, safety, experience, access, cost) of healthcare provided to Somatus patients. The VP, Medical Management will work closely as the clinical partner to the clinical operations team to assess performance across payer-product customers and geographies and to reliably achieve top decile market leading performance. Works closely with clinical data analytics team to develop, refine, and deploy medical management dashboards and initiatives for management use across the enterprise.

The VP, Medical Management will be a key member of the corporate clinical leadership team. The VP will be expected to both develop and deploy a systematic approach to total cost of care (TCOC) improvement as part of routine market management as well as targeted centrally led strategic improvement efforts.

Responsibilities

• Provide executive clinical leadership for all aspects of value based care performance including (but not limited to): multi-payer total cost of care ($PMPM) management, NCQA HEDIS quality measures, etc.
• Serve as a clinical subject matter expert and resource for clinical program and training teams.
• Analyze, interpret and apply healthcare payer claims data around $PMPM, Unit/1000, $$/Unit metrics to systematically explore and identify opportunities to improve total cost of care.
• Experienced clinical understanding of inpatient and outpatient care delivery to be able to assess appropriate utilization and reduce low value care.
• Participates in pharmacy utilization management, case reviews, outreach programs, HEDIS reporting, nutrition service review, and health plan and provider orientations.
• Conducts and/or supports quality improvement and outcomes studies related to utilization management.
• Monitors member and provider satisfaction survey results with the utilization management process and suggests changes as needed to increase satisfaction and assure that satisfactory relationships are maintained.
• Assists, as appropriate, with the contracting process with providers and evaluates the medical aspects of provider contracts.
• Maintains up-to-date knowledge of new information, capabilities, and technologies in value based medical management as supported in health plans, ACOs, and value-based providers.
• Understands and supports patient stratification, continuous evaluation, and restratification of members for appropriate resource allocation.
• Provides periodic written and verbal reports and updates as required.
• Represents Somatus at medical group meetings, conferences, etc. as appropriate.
• Lead and attract top talent, motivate, assess, and manage performance to achieve highest and best use of talent.
  
  

Qualifications

Required

• MBA, or Masters-Degree is preferred in healthcare, or other related fields of study.
• Three (3) to five (5) years’ experience within Medical Management.
• Track record of driving process, quality, and cost outcomes while improving patient care, patient satisfaction, and patient outcomes.
• Leadership experience of people, programs, and resources.
  
  

Preferred

• Graduate of an accredited medical school with M.D. degree.
• Three (3) years of physician experience preferred.
  
  

Knowledge, Skills, & Abilities

• Ability to combine leadership skills with clinical acumen to integrate best in class Medical Management.
• Entrepreneurial spirit and ability to drive change that will stretch the organization and push the boundaries.
• Ability to synthesize and interpret large amounts of disparate data.
• Comfortable with ambiguity and uncertainty.
• The ability to adapt nimbly and lead others through complex situations in a fast-paced environment.
• Risk-taker who seeks data and input from others.
• Thorough understanding of all aspects of Medical Management.
• Excellent interpersonal, verbal, and written communications skills.
• Consistently completes continuing education activities relevant to practice area and needed to maintain licensure.
  
  

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely-held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company. All requests for proof of vaccination or for exemptions from the vaccination requirement will be subject to any limitations stipulated by current state and/or federal laws. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.