State Licensed AVP of Case Management

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