Bring your medical affairs leadership, managed care Medical Director experience and clinical background to this new health plan in Mississippi. *You must hold a current Mississippi medical license and be willing to practice concurrently while in this role.
What you will do:
• Provide leadership to the health plan in the areas of strategic planning, strategy execution and implementation of care management programs, including such programs as Quality Improvement, Utilization Management, Care Management, Predictive Modeling, and Disease Management.
• Lead the health plan's analysis of medical care cost and utilization data. Lead and manage the development of techniques to effectively correct identified and anticipated utilization problems while assuring that our members receive the care they need.
• Provide leadership, direction and oversight functions to the health plan's medical management staff designed to achieve best in class performance as defined by identified metrics.
• Offer a positive leadership role in key health plan medical management initiatives aimed at optimizing utilization of medical resources.
• Oversee and direct the rendering of medical management decisions at all levels of the health plan that maximize benefits for our members while pursuing and supporting corporate objectives.
Required License, Certification, Association
State Medical License
5 + years managed care administrative experience to include NCQA or URAC.