We have been retained by Geisinger Health Plan (“GHP” – www.thehealthplan.com) to perform a national search for an Associate Vice President, Health Services Operations in Danville, Pennsylvania.

 

 About the company

GHP, a not-for-profit health maintenance organization (HMO), serves the health-care needs of members in 42 counties throughout central and northeastern Pennsylvania. Begun in 1985, the Health Plan has steadily evolved into one of the nation's largest rural HMOs by providing high quality, affordable health-care benefits.

Their roots evolved from a rural, prepaid health plan offered as a pilot program in 1972 to Geisinger Medical Center employees and residents of the five counties that surrounded the hospital. The five counties included Montour, Columbia, Northumberland, Snyder and Union. In 1985, the Health Plan received its Certificate of Authority to operate an HMO under the authority of the Pennsylvania Health Maintenance Act of 1973. The Health Plan had a significant premium advantage during the period of escalating health-care costs in the 1980s and '90s. Membership grew rapidly, and the Health Plan currently serves over 230,000 lives.

The following press release highlights GHP as a top-ranked health plan: 

“Nov. 12, 2009, Danville, PA – Geisinger Gold and Geisinger Health Plan (GHP) are the          top-ranked commercial and Medicare health plans in Pennsylvania and in the top      ten            nationally for quality and service. U.S. News & World Report produces their annual America's Best Health Insurance Plans list in conjunction with the National Committee for Quality Assurance (NCQA). Geisinger Gold is ranked #3 among Medicare plans and Geisinger Health Plan is ranked #6 among commercial plans, according to the 2009-10 list.

More than 220 commercial and 150 Medicare plans are ranked in America's Best Health Insurance Plans 2009-10 list. As the health-care reform debate moves forward, it is more important than ever before for consumers to have an apples-to-apples comparison of health-care quality and customer satisfaction.”

 

About the position:

The Associate Vice President reports to Janet Tomcavage, RN, MSN, Vice President of Health Services.  This is a new position which will oversee 100 employees in the operational areas of Health Services including, but not limited to:

 

• Medical Management
• Utilization management including concurrent review (telephonic and on-site);
• New product development and implementation; and,
• Vendor relations.
• Quality Improvement
• Strategic programs/quality planning;
• HEDIS Initiatives; and,
• Medical Care Concerns.
• Appeals and Accreditation
• Compliance with regulatory agencies and audits; and,
• Support all accreditation standards, including: NCQA, DOH, DOI, etc.

We are looking for a motivated, enthusiastic and effective change manager who creates a climate in which people want to do their best.  The ability to function within a large organization and good business acumen are a must.  The successful candidate will be highly innovative, self-directed and hands-on.  We are looking for someone to create state of the art medical utilization management systems by analyzing existing programs and maximizing returns on investment for these programs.  A clinical background in medical, nursing or other allied health fields is preferred.  However, candidates with strong project analysis and management skills may also be considered.  Other key requirements:

• Degree in health related or business field; Advanced degree in health care/Health Care Administration or Business required; 
• Five to seven years experience with managed care and utilization management; and,
•  Ability to work within a complex, integrated delivery system.

Key short-term goals for the Assistant Vice President:

• Develop positive working relationship and credibility with network facilities and providers to maximize outcomes for GHP members.
• Assume management of workflow change management processes in Health Services Operations to increase efficiencies and customer satisfaction.
• Represent Health Services Operations through the implementation of new platform for utilization management, case management and wellness.

 

About the city:

Danville is located in northeastern Pennsylvania (102 miles from Philadelphia), close to New York and the Poconos for winter snow and ski activities. This rural community offers a variety of outdoor activities.  Several golf courses provide ample opportunity for beginners to skilled players.  PPL's Montour Preserve features over 14 miles of hiking and walking trails, picnicking, fishing and boating on Lake Chillisquaque.  Additionally, Knoebels Amusement Resort, America's largest free admission amusement park, is located only 20 minutes away and is open from spring through early fall.  See http://www.bloomsburg.org/danville.html for more information.

 

More details:

The attached position description will give you more specific information about this opportunity and the organization.  GHP offers a competitive salary and compensation package.  Please review and let us know your thoughts.   Whether or not you are interested personally, we would love to get your feedback and ideas.  Please contact me directly, or let me know a good time and number to reach you.  Thank you!

Rosie Saenz, Principal

702-968-8050 Office

702-561-8226 Cell

 rosie@morganconsulting.com

	GEISINGER HEALTH SYSTEM DEPARTMENT OF HUMAN RESOURCES JOB DESCRIPTION
	TITLE: Associate Vice President, Health Services Operations (GHP) JOB CODE:   FAMILY/GRADE: 99 Executive /08 FLSA: Exempt DEPARTMENT: Geisinger Health Plans LOCATION: System
JOB SUMMARY: Develops overall strategy and goals for GHP’s Health Services Operations by providing constant, innovative leadership and direction to the design, implementation, analysis monitoring and reporting of Medical Management, Quality Improvement, Appeals, and Accreditation across all product lines including HMO, PPO and Medicare. Assists with overall strategic planning for these areas as it relates to other departments in GHP.  In addition, responsibility includes staffing and budgeting accountability for direct areas. Directly accountable to the Vice President, Health Services, Geisinger Health Plan.   MAJOR DUTIES AND RESPONSIBILITIES: 1. Assures the mission, goals and values of GHP are maintained within health services operations including Medical Management, Quality Improvement, Appeals, and Accreditation. 2. Responsible for the overall operations within Health Services specifically related to Medical Management, Quality Improvement, Appeals, and Accreditation. Works with the Vice President, Health Services to integrate overall operations with population management strategies including wellness, disease management, case management, and innovations.   3. Responsible for strategic and tactical planning, including, but not limited to: Medical Management programs including new product development and implementation, vendor relations and interface with GHS and other providers Quality Improvement strategic programs including quality planning, HEDIS initiatives and medical care concerns Appeals programs including compliance with regulatory agencies and audits Accreditation programs strategically for the entire health plan and NCQA, DOH, DOI, etc. 4. Establishes a matrix working relationship between the Medical Management, Quality Improvement, Appeals, and Accreditation, with all other Health Services departments including Wellness, Disease Management, Case Management, Clinical Reporting, Business Operations and the Medical Directors.   5. Develops collaborative relationships with network facilities and providers to maximize outcomes for GHP members.   6. Identifies opportunities for enhanced relationships with other GHP departments to optimize quality and efficiency including Provider Network, Customer Service, Sales, etc.   7. Assures appropriate policy development, including infrastructure, staffing, electronic access and maintenance for operations. 8. Responsible for human resource issues including such areas as staff coaching/mentoring, staff development, staff competency, productivity, and performance outcome measurement. SKILLS AND ABILITIES: Management skills that include employee management and development and the responsibility for associated budget.   Project management experience.   Ability to lead and manage significant change activities.   Demonstrated leadership, management, facilitation, and networking skills (ability to think strategically) (leadership and organizational effectiveness competencies). Demonstrated project management and data analysis skills. Demonstrated competence in written, oral and electronic communication skills (interpersonal and technological effectiveness competencies). Demonstrated ability to work in a matrix relationship. EDUCATION AND/OR EXPERIENCE: Master’s Degree in Health Care/Health Care Administration or Business required. Experience with Managed Care and utilization management.   Must demonstrate ability to lead and manage significant change activities. WORKING CONDITIONS/PHYSICAL DEMANDS: Work is typically performed in an office environment. Independent travel to the sites throughout the system and surrounding communities required.       Specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.