Director of Medical Management(Paid Membership Site) - A Healthcare Company (San Bernardino, CA)
Note:
This position is based out of our Ontario, CA office, but local travel is required.
Responsibilities:
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 Develop electronic systems for member tracking Evaluate staff educational needs and coordinate training Requirements BSN required.
MSN/MS preferred.
Formal training in Medical Management/Utilization Management a plus Must have experience with IPA's and Networks.
Experience as a Case Manager, preferably within a managed care environment.
CCM preferred.
Must understand regulations and requirements related to case management.
Graduate of an accredited school of nursing.
Current California R.
N.
License.
Will require local travel within about an 80 mile radius.
Source:
.
Estimated Salary: $20 to $28 per hour based on qualifications.
This position is based out of our Ontario, CA office, but local travel is required.
Responsibilities:
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 Develop electronic systems for member tracking Evaluate staff educational needs and coordinate training Requirements BSN required.
MSN/MS preferred.
Formal training in Medical Management/Utilization Management a plus Must have experience with IPA's and Networks.
Experience as a Case Manager, preferably within a managed care environment.
CCM preferred.
Must understand regulations and requirements related to case management.
Graduate of an accredited school of nursing.
Current California R.
N.
License.
Will require local travel within about an 80 mile radius.
Source:
.
Estimated Salary: $20 to $28 per hour based on qualifications.
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