The Director of Medical Management provides clinical leadership and administrative guidance to the Medical Management department, a sub-section of the Quality Health Care Management Department. The position directs performance improvement initiatives, develops and maintains operational policies for the department and
assures regulatory compliance is a priority. Specifically, this position implements and monitors the Utilization Management (UM) Work Plan and assists in the development and implementation of policies and procedures. This position oversees prior authorization and concurrent review for medical necessity and coverage issues and monitors the effects of the Utilization Management Program. The Director identifies, communicates and holds staff accountable for performance expectations; monitors/appraises the job results/performance and promotes a positive, team-oriented work environment.
- BA/BS - Bachelors Degree or equivalent required.
- MPH or MBA preferred.
- 5 to 8 years of related experience in Healthcare / Managed Care required.
- Prior experience with supervision of administrative or nursing personnel preferred.
- Knowledge of Federal, State and Local regulations and contractual regulations, specifically Articles 44 and 49 of the Public Health Law preferred.
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Fidelis Care - 10 months ago