VP, Specialized Clinical Programs - WellMed, San Antonio


About the Job

The VP, Specialized Clinical Programs is a member of the executive management team and has responsibilities for Care Management programs for WellMed Medical Management across multiple geographies. They will serve on multiple Optum Clinical Committees and leadership teams designed to provide strategic direction for all local care delivery groups within Optum.


The position provides strategic direction, leadership and oversight for Enterprise Medical Management programs including Utilization Management, Disease Management, and Complex Case Management.  You will be responsible for planning, organizing, and directing the administration of all Medical Management Programs, providing leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff. Responsible for coordinating with appropriate personnel to meet operational program needs, ensures compliance with state/federal health plan requirements, Medicare guidelines, NCQA and health plan requirements. Provides long-term planning and oversight to ensure activities are appropriately integrated into strategic direction and operations, as well as the mission and values of the company.


The Enterprise VP of Central Care Management Operations works closely with WellMed Executive Leadership and the regional Care Management leadership as well as the Regional Dyads to achieve the goals and objectives of the Care Management Program.



Primary Responsibilites:    

Care Management Programs: Utilization Management, Disease Management, Complex Case Management, Pilot Programs

  • Designs and directs UM, DM, CM program descriptions, work plans, program evaluations and overall Model of Care

  • Directs the development, planning and execution of continual process improvement efforts, policies, procedures, and regulatory compliance functions related to care management activities

  • Provides vision and leadership to advance the care management program under WellMed to the next level of service

  • Collaborates with physician leadership to execute the implementation of the care management programs as defined by Enterprise as well as OptumCare.  Provides information / data to market leadership as requested

  • Promotes understanding, communication and coordination of all care management programs components with regions and their leadership

  • Provides oversight for all activities related to delegated and regulatory requirements including annual health plan delegation audits

  • Drives adoption of best practices and trends for UM, CM, DM activities

  • Participates in health plan CMS audits

  • Monitors / analyzes metrics / data / trends, and ensures areas needing attention are communicated to  applicable stakeholders

  • Drives UM performance to meet targets for admissions, readmission and total health care costs for the organization

  • Assists with the development of the UM Work Plan, Evaluation and the monitoring of the Work Plan activities as they related to clinical performance improvement

  • Develops operating budget as necessary and participates on various teams, committees and meetings at WellMed and OptumCare

  • Designs and directs configuration for UM, CM, DM core application system

  • Drives and assists in the design of strategic plans and management of enterprise-wide, large-scale clinical initiatives, pilots, and projects promoting quality care for seniors

  • Directs and oversees innovation initiatives, data analysis activities, and evaluation strategies for clinical programs including, but not limited to, pilot projects, grant-funded research projects, and publication endeavors related to the population we serve in multiple markets

  • Develops strategic partnerships, joint ventures and learning opportunities with medical academies / associations, academic institutions, and organizations with local, national and global impacts to population health

Required Qualifications:

  • Registered Nurse (RN) degree

  • Minimum of 10 years’ experience in clinical practice

  • Master’s degree in Healthcare or Business Administration

  • Minimum of 10 years of management-level experience in managed care, medical management programs to include 5 or more years of experience at the Director level. 

  • Ability to manage up, laterally, and within non-traditional matrix structures by influence

  • Demonstrated knowledge of the business environment and business requirements (e.g., strategy changes, emerging business needs)

  • Proven capability working with people at multiple levels organization, prefer multiple locations, multi-function

  • Excellent training and collaboration skills; excellent verbal, written communication, presentation, and facilitation skills; presentation SME with market level interface

  • Knowledge of fiscal management and human resource management techniques; proven evaluative and analytical skills; ability to analyze data / reports and make recommendations

  • Demonstrate knowledge of the business environment and business requirements (e.g., strategy changes, emerging business needs)

  • Knowledge of federal and state laws and NCQA regulations relating to managed care, and all aspects of Medical Management

  • Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public

  • Excellent verbal, written communication, presentation, and facilitation skills

  • Exceptional organizational, detail and accuracy skills

  • Ability and willingness to travel both locally and non-locally as determined by business need



Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.



Keywords: Registered Nurse, Management, Director, Managed Care, Clinical, Operations