Oversees the medical services staff (clinical & non-clinical) as well as the implementation of the organization s medical management services policies.
Manages resources responsible for identification of members, development / implementation of care plans, enhancement of quality of care, monitoring, evaluation and documentation of care.
Acts as a liaison between the care management program design, specialty services and other care management programs to ensure successful implementation of the different care programs.
Evaluates clinical, financial, and medical management data and assigns resources accordingly to ensure cost effective quality outcomes.
Promotes cost effective outcomes and improve program / operational efficiency involving clinical issues.
Evaluates operational performance data (phone reports, nursing audits ) and implements procedural or training solutions to close gaps.
Provides direction and assistance in the review, selection, development and implementation of vendor- contracted activities related to medical management programs.
Provides feedback to other departments on benefit design and clinical policies when they relate to implementation of the medical services model.
Acts as a mentor to the care management supervisors, providing leadership opportunities.
Identifies, communicates and implements strategic plans of the unit and ensures proper implementation of tactics to meet plans.
Handles managerial tasks of the Care Management Unit including the preparation of the budget and budget status, the articulation of unit objectives, the staff performance and compensation reviews as well as the staff development programs and a continuous positive work environment and team spirit.
Competencies : Managerial skills :
Managerial skills :
Excellent communication & presentation skills
Technical skills :
Computer knowledge, excel, MS Word, and web-based applications
Personal Attributes : Team oriented
Customer service orientation
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