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Medical Management Manager

AltaMed Type Full time Posted 5/13/2014
Salary - n/a - Starts - n/a -
CA - California (All) - Los Angeles Referral 387    

Join a company ranked among the TOP 25 Companies to Work for in Los Angeles!

Join AltaMed’s team of multicultural health care professionals in serving more than 150,000 families a year. Our integrated system emphasizes prevention and healthy living to reduce health care disparities in multi-ethnic communities and avoid unnecessary trips to the emergency room or other more costly forms of care.

AltaMed is the largest independent Federally Qualified Community Health Center in the U.S., with more than 930,000 annual patient visits. Our culturally competent physicians and health care professionals provide integrated primary care services, senior care programs, and health and human services at 43 accredited sites in Los Angeles and Orange Counties. Established in 1970, AltaMed is proud to be a national model for the delivery of quality, patient centered care to underserved communities. We currently have an excellent opportunity for the following:

Medical Management Manager
Los Angeles - 90002
Full Time – Regular, Position Req. #387

Responsibilities

•           Oversee and manage the day-to-day operations of the Utilization Management Department, including health plan delegated activities and medical management initiatives.

•           Evaluate and monitor medical appropriateness determinations and care coordination activities.

•           Develop and implement strategic plans directly impacting cost containment and improved patient outcomes.

•           Oversee referrals and authorizations of outpatient and inpatient clinical care coordination functions.

•           Ensure compliance with regulatory requirements and application of clinical decision support criteria for care management activities deemed by federal, state, and other regulatory and accreditation agencies.

•           Perform audits of the following: utilization review referral activity, complex case management outcome measures, denial management, and all other audits required for performance improvement.

•           Oversee activities of utilization review as applicable to delegated entities.

•           Provide direction and education on managed care utilization review operating systems.

•           Monitor medical management activities to ensure compliance with policies and procedures.

•           Assist in coordinating integration between medical management delegated activities, IPA and contracted Health Plan. Monitor and analyze the productivity and quality of these managed care operations, while providing ongoing feedback and education to the staff.

•           Coordinate with the Compliance Department for Health Plan deliverables: delegation oversight audit requests, focus audit requests, and/or corrective action plans.

•           Complete corrective action plans on identified deficiencies and create, implement and monitor changes and reporting outcomes.

•           Develop health plan workplans (complemented by policies and procedures) to include SMART goals, interventions and measurable outcomes.

•           Use and/or oversee the use of data analysis and process improvement tools.

•           Work collaboratively with the entire organization to be in a state of continual readiness for Delegation Oversight Audits performed by health plans.

•           Adhere to AltaMed HIPAA Compliance Plan and the Privacy Standards Confidentiality Agreement.

Qualifications

•           California Registered Nurse with active, unrestricted license

•           Bachelor’s degree in Nursing or related healthcare field preferred

•           Minimum 5 years’ experience in managed care at the hospital or insurance industry level with at least 1+ year(s) in a supervisory capacity or its equivalent

•           Experience managing remote employees preferred

•           Experience managing projects and initiatives from initiation through completion

•           Knowledge of state and federal regulations

•           Experience with EHR systems highly desirable

•           Proficiency using computer and computer system (including hardware and software) to perform necessary functions

•           Effective written communication skills for the needs of the audience

•           Excellent interpersonal skills

•           Dedicated attention to detail

•           Ability to analyze and interpret reports and data for management purposes

•           Ability to work collaboratively with all levels of management, particularly medical management and network management

AltaMed offers extensive opportunities for professional development, as well as competitive salaries and excellent benefits. Our team members enjoy medical, dental and vision plans, retirement plan with matching employer contributions, tuition reimbursement, continuing education programs, and much more.  We invite you to join us in making a difference in our communities and in the lives of others.

For immediate consideration, please apply online at AltaMed.org.

AltaMed is fully committed to Equal Employment Opportunity and to attracting, retaining, developing, and promoting the most qualified employees without regard to their race, gender, color, religion, age, or any other characteristic prohibited by state or local law. We are dedicated to providing a work environment free from discrimination and harassment, and where employees are treated with respect and dignity.

View a full list of open positions and apply online at AltaMed.org.

AltaMed is accredited by The Joint Commission. EOE M/F/D/V