Director, Medical Management - Case Mgmt

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Location
Sacramento, CA
Salary
$150,000 - $165,000
Job Type
Direct Hire
Degree
Bachelor of Science
Date
Jan 13, 2019
Job ID
2650807

Seeking an Executive leader committed to the medical management function, who thrives on coaching and mentoring a large organization, has a creative and visionary style of leadership with excellent communication skills

Are you looking for an opportunity to shine and have ideas that can make a positive impact on programs of care management?
Do you have creative ideas and want to work with a GREAT Team?
The Director will work closely with the Medical Informatics team to identify trends that need to be addressed with program management, developing productivity standards, Utilization Management and/or Case or Disease Management Program Plan development, budget planning, project development and process improvement (six sigma or other), analytical and decision-making skills.

  • Effectively manages the activities of staff providing leadership and guidance.
  • Interviews, recommends for hire, and evaluates staff, and counsels and confronts unsatisfactory performance promptly and fairly and administers corrective action.
  • Identifies department goals and objectives, develops and communicates action plans through regular staff meetings and other communications, uses a team approach to problem solve and sets clear expectations. 
  • Identifies training needs and develops and participates in staff training. Provides a challenging and supportive environment and delegates appropriately. Seeks additional training opportunities through outside sources.
  • Analyzes work plans developed by subordinate managers and monitors the status of their work in relation to the overall schedule requirements.
  • Develops monitoring systems and measurements and exhibits a customer service philosophy.
  • Manages statistical and qualitative information concerning patient outcomes and physician/hospital practice patterns in accordance with health plans’ utilization standards.
  • Intervenes with hospital or physician contractors to examine cases to ensure methods for meeting these utilization standards while maintaining precedent for the quality of case standards.
  • Determines and enforces - through functional groups - medical management requirements in accordance with real company needs, based on current regulations and state-of-the-art product development. 
  • Organizes and promotes medical management functions. 
  • Evaluates and develops improved techniques for the control of quality and reliability. 
  • Plans and develops improved techniques for the control of health care costs. 
  • Plans, on a quarterly or longer basis, the overall use of resources.
  • Provides information and advice to higher level management related to medical management.
Qualifications:

Education/Experience:
Bachelor’s degree in Nursing or equivalent required;
Master’s degree in Health Services Administration or equivalent desired.
5 years clinical experience in an acute care setting.
4 years experience in quality management/improvement in a health care setting.
2 years work experience in a managed care environment.
5 years management experience in a health care setting.
3 years medical management experience in an HMO setting desired

License/Certification:
Must have and maintain current valid and unrestricted Registered Nursing (RN) license.
Valid state driver’s license
U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security.