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Somatus Vice President, Medical Management in Helena, Montana

Vice President, Medical Management at Somatus



The VP Medical Management, under direction of the Chief Medical Officer, is responsible for providing executive clinical leadership to direct and advance enterprise-wide efforts to improve measurable value (quality, safety, experience, access, cost) of healthcare provided to Somatus patients. The VP will work closely as the clinical partner to the VP Clinical Program Integrity to assess performance across payer-product customers and geographies and to reliably achieve top decile market leading performance. Works closely with clinical data analytics team to develop, refine, and deploy medical management dashboards for management use across the enterprise.

The VP Medical Management will be a key member of the corporate clinical leadership team alongside the VP of Clinical Strategy, the VP of Clinical Program Integrity, and VP of Clinical Affairs. The VP will work closely with Market Medical Directors to explore, identify, and operationalize targeted work to help improve market specific opportunities. Expect the VP to develop and deploy both a systematic approach to TCOC improvement as part of routine market management as well as targeted centrally led strategic improvement efforts.

Essential Duties and Responsibilities:

  • Provide executive physician leadership for all aspects of Value Based Care performance including (but not limited to): Multi-payer Total Cost of Care ($PMPM) management, NCQA HEDIS quality measures, etc.

  • Serve as a clinical subject matter expert and resource for Clinical Programs

  • Analyze, interpret and apply healthcare payer claims data around $PMPM, Unit/1000, $$/Unit metrics to systematically explore and identify opportunities to improve total cost of care.

  • Experienced clinical understanding of inpatient and outpatient care delivery to be able to assess appropriate utilization and reduce low value care

  • Participates in pharmacy utilization management, case reviews, outreach programs, HEDIS reporting, nutrition service review, and health plan and provider orientations.

  • Conducts and/or supports quality improvement and outcomes studies related to Utilization Management as required by the state Departments of Health.

  • Monitors member and provider satisfaction survey results with the Utilization Management process and suggests changes as needed to increase satisfaction and assure that satisfactory relationships are maintained.

  • Assists, as appropriate, with the contracting process with providers and evaluates the medical aspects of provider contracts.

  • Maintains up-to-date knowledge of new information, capabilities, and technologies in value based medical management as supported in health plans, ACOs, and value-based providers.

  • Understands and supports patient stratification, continuous evaluation, and re-stratification of members for appropriate resource allocation.

  • Provides periodic written and verbal reports and updates as required.

  • Represents Somatus at medical group meetings, conferences, etc. as appropriate.

  • Lead and attract top talent, motivate, assess, and manage performance to achieve highest and best use of talent.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Required Education and Experience:

  • Graduate of an accredited medical school. M.D. Degree is required.

  • MBA, or Masters-Degree is preferred in healthcare, or other related fields of study.

  • Three (3) years of physician experience preferred.

  • Three (3) to five (5) years’ experience within Medical Management.

  • Track record of driving process, quality, and cost outcomes while improving patient care, patient satisfaction, and patient outcomes.

  • Leadership experience of people, programs, and resources.

Knowledge, Skills, and Abilities:

  • Ability to combine leadership skills with clinical acumen to integrate best in class Medical Management.

  • Entrepreneurial spirit and ability to drive change that will stretch the organization and push the boundaries.

  • Ability to synthesize and interpret large amounts of disparate data.

  • Comfortable with ambiguity and uncertainty.

  • The ability to adapt nimbly and lead others through complex situations in a fast-paced environment.

  • Risk-taker who seeks data and input from others.

  • Thorough understanding of all aspects of Medical Management.

  • Excellent interpersonal, verbal, and written communications skills.

  • Consistently completes continuing education activities relevant to practice area and needed to maintain licensure.

Physical Requirements

  • This job operates in a professional office setting. While performing the duties of this job, the employee is regularly required to sit for extended periods of time. Normal manual dexterity is required.

  • Normal speaking and hearing abilities to interact with others in an office environment, over telephone or other video conferencing platform.

  • The employee is occasionally required to stand; walk; and reach with hands and arms and continuously repeat the same hand, arm finger motion many times as in typing.

Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company pursuant to applicable law.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions .

Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.