This division is one of the fastest growing businesses in a company with the largest and most successful Medicaid business in the nation.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company. RELOCATION AVAILABLE
Responsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost effective medical care is received and for the day-to-day management of medical management staff.
Primary duties :
- Interprets existing policies and develops new policies based on changes in the healthcare or medical arena. Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
- Identifies and develops opportunities for innovation to increase effectiveness and quality.
- Serves as a resource and consultant to other areas of the company, may chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees, conduct peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, provides guidance for clinical operational aspects of the program.
- Supports the medical management staff ensuring timely and consistent responses to members and providers.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports and directly supervises the management of any assigned staff.
- Requires M.D. or D.O.; Board certification approved by the American Board of Medical Specialties required where applicable to duties being performed, Must possess an active unrestricted medical license to practice medicine or a health profession.
- Experience in Medicaid Managed Care Health Plans