Medical Management Director – CSMV, Managed Care & TRICARE Experience Preferred
CareSource
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $113,000 - $197,700 per year
Job Level
About the role
- 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
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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
utilization managementcase managementpopulation health strategiesbehavioral health integrationclinical quality monitoringpharmacy managementprior authorization processesbenefit determinationsservice determinations
Soft Skills
strategic leadershipoperational leadershipcommunication skillsexecutive-level communicationability to manage competing prioritiesability to meet deadlinesorganizational skills