Senior Director, Medical Management Operations
Atlanta, GA 30301
- Drive execution of Corporate Medical Management projects and initiatives to bring greater effectiveness, efficiency and consistency across Health Plans.
- Develop effective and innovative medical management programs, processes, and models keeping abreast of medical trends, industry changes and state requirements.
- Evaluate existing medical management practices across Health Plans.
- Facilitate cross-functional/cross-Health Plan work teams to identify best practices and improvement opportunities.
- Develop work plans and drive execution.
- Utilize continuous process improvement techniques to explore approaches to work processes to eliminate waste and ensure resources are allocated to high value activity.
- Develop and drive implementations of new medical management processes/programs.
- Establish standardized "play books" to ensure effectiveness and efficiency.
- Collaborate with Health Plans and Corporate Medical Affairs to ensure accreditation standards are achieved in Utilization Management and Case Management.
- Partner with Specialty Companies and Health Plans to implement programs and processes to efficiently improve member outcomes.
- Maintain corporate level policies and procedures.
- Collaborate with Health Plans to adopt and modify Health Plan specific requirements to ensure compliance with state contractual requirements.
- Provide overall direction to Corporate Medical Management Training team.
- Collaborate with Medical Management Systems to ensure appropriate infrastructure is in place to execute new programs and processes.
- Develop consistent key performance metrics to monitor Medical Management processes.
- Analyze data to evaluate effectiveness of existing and new medical management programs, and modify programs based on findings.
- Bachelor's degree in Nursing or related field.
- 7+ years of related Medical Management experience in a managed care environment.
- Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
- RN license preferred.
- Quality, reporting and analytics experience is highly desired.
- Strong training experience is a preferred.
- Familiar with NCQA and CMS standards is desired.
- Six Sigma Certification is a plus.
For more information, please contact our office at 877-782-3334.