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Reference Number:
2009-95
Job Description:
Responsible for and supervise all aspects of integrated care management for the medical, behavioral health, and social care management teams. Work with Medical and Behavioral Health Medical Directors, Associate Medical Directors, and Chief Medical Officer to achieve the clinical affairs management goals for the company?s membership including appropriate utilization of healthcare services and quality of care. Interface and coordinate efforts with other internal departments including claims, provider relations, member/customer service, contracts, regional development, finance, and IT in support of clinical affairs management initiatives and operations. Responsible for medical expense reduction and quality improvement initiatives by developing new and updating existing case management protocols and integrated care management strategies as business demands for company?s. Work with other clinical directors and senior directors to assure continuity of clinical programs and goals. Develop and maintain a positive work environment that supports overall team effort of the company?s Integrated Care Management department. Maintain and develop department allocated budget in conjunction with the Medical director and Director of Finance. Attend activities including medical and other professional organizations. Remain current with all clinical affairs trends, policies, practices, and workflows; ensure that staff complies with all required activities including security, privacy, and clinical protocols as appropriate. RN, BSN, MSN, or LICSW preferred. CCM preferred. Appropriate clinical license and certification in Case Management is desirable.
Experience Level:
Unspecified
Requirements:
Bachelors degree required or 5 to 8 equivalent years experience in Case Management. MBA preferred.
7 to 10 years of case management experience in a Managed Care environment is required. Demonstrated understanding of and proficiency in the principles, concepts, and techniques of health care management and integrated case management principles. Minimum 7 years of clinical practice. Health Plan experience preferred.
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