This position will be responsible for directing all aspects of the assigned Medicaid Contracts. The successful candidate will oversee Utilization Management (UM) and Utilization Review (UR) for the assigned medicaid contract.
Plans and directs all activities required in the contract including responsibility for all contract deliverables. Exercises independent judgment and discretion with development and execution. Provides technical guidance as needed and ensures all issues are resolved accurately and timely. Ensures all Company and legal requirements are met with the end results meeting the client/customer satisfaction.
Maintains positive relationships with the Medicaid Agencies and other stakeholders in the state. Partners with health care or professional organizations. Stays abreast of healthcare trends and national guidelines/standards of care.
Selects, develops, and manages employees to achieve individual, team, and organizational success. Ensures employee accountability through routine observation, performance measurement, and performance feedback. Fulfills Telligen’s Management Philosophy that "Managers coach, engage, and support our people to achieve results". Provides resources and support as needed to meet the specific contract/program requirements.
Represents the Company or business unit at meetings with facilities, providers, clients and potential clients. Makes presentations ensuring the division and Company project a professional and knowledgeable image. Maintains positive relationships with internal and external business heads and staff.
Ensures unit is running in a cost effective manner by managing and monitoring financials. Makes adjustments and recommendations as needed.
Performs miscellaneous duties as assigned.
Masters or Bachelors degree in health care, management, nursing, or public health; and/or equivalent experience in health or human services. Minimum 5 years experience in a health care environment, including care management and/or health care quality improvement; minimum 5 years managing a professional staff; demonstrated experience leading and managing a Medicaid Program.
Positions working on specific contracts may require U.S. Citizenship.
15% local and overnight travel
Telligen and its affiliates are Affirmative Action and Equal Opportunity Employers.
Attention to Detail
Noise level is moderate.
Sensitivity level of information handled in position: medium