MemorialCare Medical Foundation has an outstanding opportunity for a Vice President, Medical Management. This is an opportunity to lead and provide direction for the Medical Management operations and set the scope of activities related to Referral Management, Disease Management, Regulatory Compliance and Quality Management. The position reports directly to the Chief Medical Officer and has direct leadership responsibilities over all Directors and indirect reporting responsibilities of Managers, Supervisors and Staff within the Medical management Department of the MemorialCare Medical Foundation.
Key responsibilities include: * Provide exceptional leadership to the medical Management Staff. Ensures all department functions are staffed appropriately and that all department processes are completed by department staff in a timely and accurate manner. * Identifies opportunities for employee and process improvements and ensures training and skill development is provided either through direct involvement or delegation to the management team. * Develops and implements annual reviews of the results of the Quality Improvement and Utilization Management plans. * Develops and facilitates the successful performance of medical management processes, policies and procedures to assume that medically necessary services are delivered efficiently, at optimal cost and in an efficient manner. * In partnership with others, identifies areas of over or under clinical utilization through the use of data and tools provided by the Finance and Decision Support departments. * Develops, monitors and implements department budget.
* Minimum of 10 years’ experience in medical management with IPA’s, medical groups or HMO’s. * 5-7 years’ experience with an IPA or medical group. Prior medical management experience of multiple departments of functional areas within a managed care setting. * Familiarities with Federal and State governmental care regulations and accrediting agency requirements. * Bachelor’s degree in Nursing or healthcare related field required. Master’s degree in Business Administration or health care related field preferred. * Current California RN license is required. * Experience and knowledge of HIPPA rules and regulations along with a strong background in strategic planning, financial analysis and contract negotiations.