Regional Director (Eastbank Team)
Peoples Health, Inc. - Metairie, LA

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To provide regional oversight to an assigned service area. As part of the Peoples Health Medical Management Team, position is designed to ensure the clinical care coordination across the care continuum. The Regional Director duties include oversight of health services appropriately provided in inpatient and outpatient facilities, including contracted and non-contracted providers within an assigned service area.

Responsibilities:
Plans, organizes, ensures administration of Plan benefits, and monitors the functions of clinical staff and work tools required for the effective operation of the regions outside New Orleans medical management offices
Responsible for staffing the regional medical management office, including hiring and recruitment
Responsible for the ongoing training of staff, including the familiarization of network products and services, health care procedures, company policy and education required to maintain credentials of staff
Communicates with physicians, hospital administrators and other members of the health care team on any medical management issues within these guidelines;
Emergency (No delays, within same hour as request/issues)
Urgent (Within 12 hours of request)
Routine (within 2 business days)
Works with regional medical management team to promote member satisfaction, educates staff on the health care contract system and the professionalism and skill necessary for the delivery of quality health care
Documents member complaints and works with appropriate matrix partners to resolve them
Plans and schedules staff meetings, in-services, and joint practice meetings with select providers
Responsible for providing feedback to staff on an on-going basis, to ensure performance standards and goals are met
Acts as a positive role model and leader to staff with regard to customer service, cost management, quality of care and interpersonal skills
Contributes innovative ideas to facilitate and improve regional department and overall department functions
Effectively communicates to regional outside New Orleans administrators, contacts and additional Peoples health staff
Ability to effectively implement change, champion new initiatives and support corporate decisions
Manages utilization management issues and reports with Finance, Network Administrators, Board and other matrix partners
Establishes and develops team with Field Supervisor, Reviews plans through routine or establishes meetings with Director of Network Medical Management
Establishes objectives/goals pursuant to the Medical Management mission
Review and comply with the Code of Ethics and HIPAA, Confidentiality and all relevant Company and Regional policies and procedures, and local, state and Federal laws and regulations
Presents utilization statistics and learns to use data to support decisions on a daily basis. A team lead in understanding statistics and guides the team in appropriate response to the data
Completes service forms in accordance with department policy including time-lines and standards of documentation

Qualifications:
Bachelor's degree or advanced degree preferred. RN with current license to practice in the State of Louisiana required for RN. Must have 3 years experience in health care and a minimum of 2 years in a supervisory, management or administrator role. Minimum of 5 years in managed care, including Utilization or Quality Management, Health Services and Medical Management or other related MCO departments/ functions. Excellent communication skills required. Must be able to problem solve and make necessary decisions. Certification in utilization management or case management preferred.

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