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Supervisor, Medical Management

Company: Cenpatico
Location: Westmont
Posted on: October 24, 2019

Job Description:

Supervisor, Medical Management USA-Illinois-Westmont Position Purpose: Supervise the day to day operations of the medical management, utilization and case management functions * Oversee changes to medical service functions and performance in relation to company mission, philosophy objectives and policies, as directed * Assist senior management with budgets and forecast for strategic planning and key initiatives. Balance current future needs effectively * Ensure compliance with established onsite and concurrent review, case management, referral, pre * authorization policies, procedures, and processes * Assure that Medical Services functions and responsibilities are coordinated with other operating departments of the Plan and Corporate * Assist senior management with statistical analysis of utilization data * Participates in NCQA accreditation of the Plan * Participate in case review with Medical Directors and act as resource for appeals function Education/Experience: Nursing degree, state registered nursing license, and advanced degree preferred. 3+ years nursing experience. 1+ year quality improvement, case/utilization management in a healthcare environment, preferably managed care. Previous experience as a lead in a functional area or managing cross functional teams on large scale projects. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Clinical & Nursing Full-time

Keywords: Cenpatico, Cicero , Supervisor, Medical Management, Executive , Westmont, Illinois

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