Medical Management Director – CSMV, Managed Care & TRICARE Experience Preferred
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Job Description
Medical Management Director leading CareSource's integrated medical management model. Overseeing utilization management, case management, behavioral health, and pharmacy management functions.
Responsibilities:
- 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
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