✨ About The Role
- Responsible for overseeing all Medical Management activities for the region
- Directs the administration of Care Management and Advance Care Management programs
- Ensures compliance with state and federal health plan requirements, Medicare guidelines, NCQA, and URAC standards
- Manages staffing ratios, assignment of duties, and supervision of Medical Management staff
- Develops and implements programs to eliminate inappropriate use of medical resources
âš¡ Requirements
- Experienced leader with a background in medical management and operations
- Strong communication skills to effectively interact with internal and external stakeholders
- Ability to lead and develop a team, ensuring compliance with regulations and standards
- Proven track record in budget management and resource allocation
- Detail-oriented individual with a focus on customer service and quality improvement initiatives