"Lighting a Path to the Future"

Director, Medical Management Operations - Tempe

Location: TEMPE, AZ
Job Type: Direct Hire
Salary: $110,000.00 - $135,000.00
Degree: Bachelor;
Date: 11/29/2017
Job ID: 02545765
Job Description

Director, Medical Management Operations - Tempe

Rapidly expanding market - national healthcare enterprise!

Innovative, process- driven leader will be called on to lead Medical Management process improvement initiatives to reduce medical costs, reduce administrative costs, and improve member quality.


Assist Medical Management clinical leadership team to establish baseline and target metrics for key business/functional processes


Develop and analyze reports across multiple systems to analyze key business drivers and trends in order to develop appropriate mitigation initiatives


Collaborate and provide analytical support to Medical Management clinical leadership to facilitate the development, implementation, and evaluation of performance improvement initiatives.


Develop processes to increase effectiveness and efficiency, while ensuring compliance with NCQA and contract requirements


Lead end to end process evaluation from medical management processes to associated claims payment


Develop and facilitate implementation of business processes to leverage technology to increase effectiveness and efficiency; integrating multiple systems to maximize outcomes


Develop and implement a consistent methodology to evaluate pilots, processes, and programs


Provide leadership and direction to Preauthorization Workforce Management team


Qualifications:

Bachelor's degree (Master’s degree is a plus)

Not required to be a clinician but need to have deep understanding of the clinical aspects as well as the operational/audit.

 7+ years of related medical management, operations, analysis, and managed care experience.

Advanced knowledge of Excel and Access.

 Previous leadership and staff development expertise.





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