Director, Medical Management
NAMM North America Medical Management - Ontario, CA

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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.

Responsibilities:
  • 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
Qualifications:
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

IND123

*CB

*MW

About this company
North American Medical Management, California, Inc. (NAMM) develops and manages provider networks, offering a full range of services to...