Manager Medical Management

Job Overview

Position Title: Manager, Medical Management. Responsible to manage a team of clinicians charged with promoting quality member outcomes, optimizing member benefits, and promoting effective use of resources.

Responsibilities

• Ensure adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective.


• Oversee authorization of inpatient admissions, outpatient services, surgical and diagnostic procedures, out‑of‑network services, and appropriateness of treatment setting.


• Interpret benefits and managed care products and steer members to appropriate providers, programs, or community resources.


• Apply clinical knowledge to coordinate care with facilities and providers.


• Manage appeals for services denied.


• Hire, train, coach, counsel, and evaluate performance of direct reports.
Full-time Bio & Pharmacology & Health