Indiana Jobs

Mobile Indiana Career Connect Logo

Job Information

McLaren Health Care Mgr Medical Management in Indianapolis, Indiana

Description

Position Summary:

Responsible for all aspects of the Medical Management process from the determination of the appropriateness of care to ultimately improving health outcomes. Responsible for the education, monitoring and evaluation of the Medical Management staff for all product lines. Evaluates, designs, implements and adjust workflows to ensure accuracy and department efficiencies. Manages Medical Management processes to be appropriate; compliant with NCQA standards and regulatory agencies and within budget. Develops and implements departmental policies and procedures as well as documentation of the case management and utilization management processes. Responsible for the ongoing assessment and delivery of the Quality Improvement Performance Plan (QPIP) to facilitate that quality standards are met, with a focus on all assigned NCQA standards. Intervenes with providers when utilization patterns deviate from acceptable utilization standards. Combines utilization information with quality goals and acts accordingly to ensure high quality, cost effective care is being delivered. Works collegially with Medical Leadership to identify opportunities for improved quality and cost effectiveness.

Qualifications

Qualifications:

Required:

  • Valid RN License in Indiana

  • Bachelor’s Degree in Nursing, health care or business

  • Three (3) years clinical experience

  • Five (5) years experience in the progressively more complex Medical Management arena in Managed Care, such as case management, utilization management and/or quality improvement (i.e. HEDIS, NCQA) with at least two (2) years in a supervisory role for professional clinical staff of five or more members leading or assisting in all phases of effective supervision (ie. Recruitment, performance management, training)

Preferred:

  • Seven (7) years experience and knowledge of Managed Care functions (e.g, medical delivery, regulatory compliance, HEDIS, NCQA)

  • Three (3) years experience in ambulatory medical management

Job: Manager

Primary Location: Indiana-Indianapolis-MDwise Inc

Organization MDwise

Employee Status Regular

Shift Day Job

Job Type Standard

Schedule Full-time

Req ID: 20004528

DirectEmployers