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Director, Utlization - Medical Management - Harrisburg, PA

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Harrisburg Area, PA
$100,000 - $125,000
Job Type
Direct Hire
Sep 08, 2017
Job ID

Director, Utlization - Medical Management - Harrisburg, PA

Unique opportunity for an experienced leader to select and develop your own team. Generous relocation- excellent analytic tools and support. 

- Direct medical management program including UM, case management, QI and credentialing.
- Develop department objectives and implement action plans to achieve objectives.
-  Evaluate and implement changes to medical service functions and performance.
-  Manage budget and forecast for strategic planning and key initiatives.
-  Coordinate with operating departments on research and implementation of best practices.
-  Statistical analysis of utilization data on programs.
-  Participate in NCQA, State, and/or other accreditations of the Plan..
-  Develop effective communication plans with external providers such as hospitals and State agencies.
-  Coordinate with Medical Director to educate and communicate expectations with providers.


Ideal Candidate Profile:

- Bachelor's degree in Nursing, related field, or equivalent experience.

-7+ years of nursing, quality improvement, and management experience in managed care.

-Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

-RN license

-Experience in PA a strong plus