One of the fastest-growing IPAs in Southern California is searching for a Director of Medical Management!

This full-time position requires a Ilinois RN license, strong clinical knowledge, and years of managed care leadership experience.

This is your chance to be a part of a growing organization founded by one of the most successful Physicians in IL.  

You can expect a Monday-Friday, 8am-5pm schedule and very generous benefits: Yearly bonuses, 3 weeks PTO, paid holidays, Medical/Dental/Pharmacy, Life Insurance, 401k matching and more.

Responsibilities:

• Development and implementation of care management and utilization management policies and procedures to ensure compliance throughout the region and consistency throughout the network.
• Maintenance of all Medical Management programs to ensure that patient care maximizes quality and continuity by utilization of appropriate resources.
• programs across the regions, and the integration of these programs within the IPA model.
• Monitors closely and analyzes all inpatient and outpatient reports and identifies trends; Makes recommendations regarding interventions to improve all resource management.
• Develops and coordinates strategies for ensuring the delivery of care in the most appropriate setting.
• Ensures that contracted providers are used and collaborates with contracting department to obtain new contracts with preferred providers based upon specific quality and utilization criteria.
• Monitor all high-risk/high-cost patients and oversees cross-regional high-cost areas of Care Management.
• Monitors provider referral patterns for appropriate utilization of specialty and ancillary services.
• Initiates organizational and system changes to improve departmental staffing efficiency and effectiveness, and care management program outcomes within the region.
• Identifies, develops and oversees the educational needs of the Care Management providers and staff including the implementation of an extensive orientation program, cross-training and proactive approach to Care management.

Minimum Qualifications:

• Bachelor’s degree from a four-year college
• Current Ilinois RN license
• 3+ years as a Manager or Director of Case Management, UR, or UM at a health plan, medical group, IPA, or MSO
• Proven working knowledge of Medicare and/or Medicaid regulations
• Case Management Certification is plus but not required  

Compensation is dependent upon education and experience.