Base Salary Range: $148,629.77 - $357,640.37 Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age. Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. This position is a member of the executive management group and reports to the Chief Medical Officer. The VP of Medical Management is responsible for the Utilization Management (UM) and Care Management (CM) functions for health plan members. This position is responsible for integrating efforts across teams, programs, and improvement activities for all lines of business to promote optimal organizational effectiveness and enhance performance. Key focus on advancing the identification, quantification, and management of risks within scope while improving member experience and outcomes. Essential Responsibilities: * Lead Care Management, Utilization Management and Health Promotion and Wellness departments for optimal performance against national benchmarks; create a multi-year improvement plan which includes various programs across lines of business (e.g. complex case management and condition support) aimed to sustain a scalable and flexible model aligned with Population Health Management. * Performs employee management responsibilities to include but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity using lean / Kaizen tools for process improvements. * Demonstrate strong oversight and discipline related to annual department budgets. * Coordinate / collaborate with Medical Directors in each Line of Business as job functions relate to care, case, physiologic risk, network, and utilization management in dyad partnerships. * Collaborate with clinical leadership to engage the enterprise, members, and network physicians to improve total cost of care and member outcomes including operational performance, clinical costs, clinical appropriateness, and authorizations. * Responsible for leading CM/UM to ensure optimal care supports for priority member populations identified through the strategic work plan and other defined stratification emphasizing continuity of care, in an effort to reduce or eliminate fragmentation, duplication, and gaps in care plans. * Collaborate with VP of Quality and VP of Pharmacy to support the development, implementation and evaluation of corporate quality improvement programs i.e. NCQA, CMS 5 Star, HEDIS, CAHPS and CCO Quality Incentive Measures. * Executive sponsorship of Medical Management Platform for CM/UM. * Develops and deploys disciplined and innovative models of care to deliver high value programs that emphasize cost effective management of CM/UM operations. * Develop and incorporate performance-enhancing systems and tools for increased automation and efficiency in the scope of work specified for increasing operational excellence (e.g., Machine learning algorithms, ePA deployment, use of bots and Artificial Intelligence to streamline operations) * Support enterprise-wide total costs of care initiatives. * Support Quality and Population Health strategies in relation to achieving the growt