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Director of Medical Management
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Ontario, CA Ontario, California |
About this job
For those who want to invent the future of health care, here's your opportunity! We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.
Responsible for providing leadership and administrative oversight, program development, implementation, and evaluation of UM Programs, chronic care programs, and support PrimeCare Medical Network, Inc., IPA Medical Management function.
Note: This position is based out of our Ontario, CA office, but local travel is required.
Responsibilities:
- Oversees one or more IPA's formal utilization and network coordination services. Provides operational oversight and recommends corrective action for all shared services
- 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
- Development of clinical practice guidelines
- Develop electronic systems for member tracking
- Evaluate staff educational needs and coordinate training
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
Requirements
- BSN required. MSN/MS preferred.
- Formal training in Medical Management/Utilization Management a plus
- Must have experience with IPA's and Networks.
- Experience with community based programs (Medicaid, for example) a plus.
- 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.
- Valid California Driver's License and insurance.
- Will require local travel within about an 80 mile radius.
North American Medical Management specializes in working with leading physicians and hospitals to successfully manage the delivery of medical services. We have developed sophisticated techniques for managing the revenue and health care expenses of medical groups. NAMM currently provides MSO services to twelve PHOs and IPAs in the Chicago area serving about 90,000 managed care lives with positive results.
NAMM is now a part of OptumHealth.
OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
OptumHealth helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Job Keywords: RN, nurse, CCM, Case Manager, CM, case management, utilization management, UM, UR, managed care, Hospital, Ontario, Manager, Director, Care Manager, Care Management, NCQA, SNP
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