Fidelis Care - Rego Park, NY

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The AVP, MLTC will be responsible for ensuring the success of all Managed Long Term Care programs by developing, implementing and managing strategies/initiatives designed to drive operational efficiencies, improve quality, enhance member/provider satisfaction, facilitate program growth and ensure regulatory compliance.

Business Experience:
  • Serve as Plan's expert regarding MLTC issues (e.g. regulations, eligibility, models of care). Represent the organization in professional and public forums.
  • Enhance member/provider satisfaction, care quality and financial performance through the development, implementation and management of process improvements targeting various functional areas (e.g. claims processing, customer service, utilization management, quality reporting, and provider service). Ensure that the MLTC program is fully integrated into the Plan's operations.
  • Direct activities of various functional areas (e.g. Marketing, Provider Relations, Enrollment, Member Services, QHCM) to facilitate membership growth through the development and implementation of growth strategies.
  • Assure quality and efficiency of clinical management functions (e.g., care management, utilization management, clinical integration).
  • Assure regulatory compliance, with marketing, operational and clinical requirements, for all MLTC programs. Maintain and enhance relationships with regulators at the State and County levels. Assure regulatory compliance with program requirements.
  • Analyze product/service programs in order to develop implementation plans to optimize productivity and performance.
  • Oversee Plan's effort to improve member satisfaction, provider satisfaction, quality of care and financial performance.
  • Effectively communicate with all levels of management, internal and external customers. Ability to work well as a member of a team or alone.
  • Job performance requires fulfilling other incidental or related duties as assigned, assisting and training others, and performing duties of higher rated positions from time to time for developmental purposes.

  • Operational, medical management, marketing and regulatory experience in a health care environment, preferably MLTC or homecare.
  • Communicate with technical and business constituencies effectively. Experience in writing business specifications and requirements.
  • BA/BS - Bachelors Degree or equivalent required.
  • 8 to 10 years related experience required.
  • MBA/MHA - Masters of Business Administration or equivalent preferred