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Director, Medical Management Operations

Little Rock, AR, USA | Centene Corporation

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
    General Management
    Operations / Production
  • Experience:
    7-10 years
Job Description:
105 people have viewed this job

Lead Medical Management process improvement initiatives to reduce medical costs, reduce administrative costs, and improve member quality.

Assist Medical Management clinical leadership team to establish baseline and target metrics for key business/functional processes

Develop and analyze reports across multiple systems to analyze key business drivers and trends in order to develop appropriate mitigation initiatives

Collaborate and provide analytical support to Medical Management clinical leadership to facilitate the development, implementation, and evaluation of performance improvement initiatives.

Develop processes to increase effectiveness and efficiency, while ensuring compliance with NCQA and contract requirements

Lead end to end process evaluation from medical management processes to associated claims payment

Develop and facilitate implementation of business processes to leverage technology to increase effectiveness and efficiency; integrating multiple systems to maximize outcomes

Develop and implement a consistent methodology to evaluate pilots, processes, and programs

Provide leadership and direction to Preauthorization Workforce Management team

Education/Experience: Bachelor's degree in Nursing, related field, or equivalent experience. Master’s degree preferred. 7+ years of related medical management, operations, analysis, and managed care experience. Advanced knowledge of Excel and Access. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. Six Sigma experience preferred.

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