Technology Innovation Sr Manager

Descripción del trabajo : The Health Plan Chief Medical Officer provides leadership in the development and execution of the Plan's disease management, case management, utilization management, and care management programs. Oversees the development of the Plan's clinical practice guidelines and provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to Plan members, targeting improvements in efficiency and satisfaction for members and providers.

KNOWLEDGE / SKILLS / ABILITIES

Provides leadership to the health plan in the areas of strategic planning, strategy execution and implementation of care management programs, including such programs as Quality Improvement, Utilization Management, Care Management, Predictive Modeling, and Disease Management.

Leads the health plan's analysis of medical care cost and utilization data. Leads and manages the development of techniques to effectively correct identified and anticipated utilization problems while assuring that our members receive the care they need.

Provides leadership, direction and oversight functions to the health plan's medical management staff designed to achieve best in class performance as defined by identified metrics.

Offers a positive leadership role in key health plan medical management initiatives aimed at optimizing utilization of medical resources.

Oversees and directs the rendering of medical management decisions at all levels of the health plan that maximize benefits for our members while pursuing and supporting corporate objectives.

JOB QUALIFICATIONS

Required Education

Doctorate Degree in Medicine

Board Certified or eligible in a primary care specialty

Required Experience

10+ years relevant experience, including :

• Minimum 5 years clinical practice.
• 5 years in a Medical Director role.
• 4 years HMO / Managed Care experience, including Utilization and / or Quality Program management.
• 5 years managed care administrative experience to include NCQA or URAC.

Required License, Certification, Association

Active and unrestricted Current State (NM) Medical License without restrictions (free of sanctions from Medicaid or Medicare).

Preferred Education

Master's in business administration, Public Health, Healthcare Administration, etc.

Preferred Experience

12+ years relevant experience.

Active and unrestricted Board Certification (Pediatrics, Family Practice, Ob / Gyn or Internal Medicine).

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