RN Senior Manager of Medical Management

Location: Phoenix, AZ
Date Posted: 05-08-2018
CareNational
RN Senior Manager of Medical Management – Health Plan
Phoenix, AZ 
 
Manager of Medical Management Job Summary:
 
  • Responsible for developing and managing the day to day processes required to provide Case Management and Utilization Management activities that promote quality, cost effective outcomes and remain compliant with all regulatory requirements.
  • Manage and oversee all staff activities related to the development and delivery of health management programs for members with both complex and chronic health care needs.
  • Provide oversight and recommendations on the cases managed through any of the programs.
  • Direct all activities required to maintain accreditation for Case and Utilization Management.
  • Responsible for monitoring and reporting department and program performance measures.
  • Evaluate, interpret, and negotiate applicable contracts.
  • Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.
  • Responsible for the review, update and accuracy of documentation, computer files, policies and procedures related to the departmental goals and objectives.
  • Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and implement operational changes and process improvement.
  • Keep status of unit current in accordance with service standards, systems, procedures, forms and manuals through staff meetings and verbal and written communications.
  • Provide motivation and encouragement to subordinates, conduct performance evaluations, identify and coordinate training needs, make determinations regarding disciplinary actions.
  • Interview, evaluate and make recommendations in regard to employment decisions.
 
Manager of Medical Management Background:
 
  • Valid, unrestricted state Registered Nurse (R.N.) license; Bachelor’s degree in healthcare related field preferred.
  • Roughly 3-5 years of recent acute care clinical nursing experience.
  • Minimum of 2-5 years of Case Management and Utilization Review experience.
  • 2 year(s) of experience in a supervisory role, overseeing UM/CM staff preferred.
  • Around 5 years’ experience at a health plan or other managed care organization (HMO/TPA/IPA/etc).
  • Experience in training / teaching staffs to meet operational requirements and goals.
  • Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
 
 
#CLINICAL
 
PRASHANT PATEL
STRATEGIC DIRECTOR
CareNational
prashant@carenational.com
480.646.3275 (CALL – TEXT – FAX)
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