Required Qualifications: RN, 3+ years of managed care leadership
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.
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.
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.