Responsible for providing leadership and administrative oversight, program development, implementation, and eavluation of UM Programs, chronic care programs, and support PrimeCare Medical Network, Inc., IPA Medical Management function.
- Oversees one or more IPA’s formal utilization, , and network coordination services. Provides operational oversight and recommends corrective action for all shared services
- Manages the UM results of one or more of the IPA’s, including referral management; acute, SNF and Rehab admissions for the IPA.
- Continually creates and implements strategies to improve IPA and UM Departments performance
- Participates in PrimeCare Medical network, Inc, IPA Utilization Management meetings to enhance communication and continuity of member care services
- Has management responsibility as assigned for the key Medical Management Programs, Coordinated Care Center, DME and Injectable Units
- Participates in determination of department’s goals and objectives, setting organizational structure, staffing, and space planning
- Participates in recruitment, retention, and training of NAMM Case Management staff.
- Acts as a resource to other departments in regards to Case Management, Disease Management, and Chronic Care Management.
- Collaborates with appropriate VP of Medical Management, Medical Directors, UM Managers, and other IPA staff as well as other division peers
- Program Development, Implementation and Evaluation
- Conduct needs assessment including: development of methods for determining potential patient enrollment, medical literature review, analysis of pre-program utilization and return on investment
- Development of Program to include establishment of policies and procedures, enrollment strategies, member and physician materials, and measurements of program outcome
- Development of clinical practice guidelines
- Develop electronic systems for member tracking
- Evaluate staff educational needs and coordinate training
Bachelors degree required, masters preferred (MHA or MBA), or equivalent years of experience or Health Care Administration and/or Managed Care Organization or related field. Formal training in Medical Management/Utilization Management a plus
Graduate of an accredited school of nursing
Current California R.N license
Valid California drivers license and insurance
North American Medical Management, California, Inc. (NAMM) develops and manages provider networks, offering a full range of services to...