Medical Management Director – CSMV, Managed Care & TRICARE Experience Preferred

Customer Success ManagerCustomer SuccessFull TimeRemoteLeadTeam 1,001-5,000Since 30+ yearsH1B SponsorCompany SiteLinkedIn

Location

United States

Posted

5 days ago

Salary

$113K - $197.7K / year

Seniority

Lead

Bachelor Degree8 yrs expExperience acceptedEnglish

Job Description

• Provide strategic and operational leadership for the Medical Management function across UM, CM, BH, PH, CQM, and Pharmacy • Oversee utilization management activities • Oversee prior authorization processes, benefit and service determinations • Ensure effective case management services • Lead population health strategies • Oversee behavioral health integration and coordination with medical and case management operations • Ensure compliance, performance monitoring, and reporting for clinical quality and pharmacy management programs • Ensure timely and accurate completion of all Government-required medical management deliverables

Job Requirements

  • Bachelor's degree in Healthcare Administration, Public Health, Nursing, or a related field required
  • Master's degree in Healthcare Administration, Public Health, Nursing, or a related field preferred
  • Eight (8) years progressive experience in medical management, utilization management, or managed care clinical operations required
  • Five (5) years in a leadership role preferred
  • TRICARE or Veteran Affairs experience preferred
  • Strong written, verbal, and executive-level communication skills
  • Ability to manage competing priorities and deadlines in a fast-paced environment

Benefits

  • Health insurance
  • Comprehensive total rewards package
  • Bonuses tied to company and individual performance

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