Join a growing team of medical management professionals at one
of the fastest healthcare companies in the country. 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
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
Qualifications: 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
Experience in Medicaid Managed Care Health Plans
Competitive compensation with benefits offered.
Contact information :