MAGELLAN HRSC, INC. Senior Manager Physician Business Management R00000015637 in Maryland Heights, Missouri
This position maintains accountability for medical management functions to achieve the business and clinical outcomes for the health plan, meeting contract requirements, National Committee of Quality Assurance (NCQA) accreditation standards, and supporting initiatives with providers and members to manage cost of care. Manages the day to day delivery, oversight and management of employed and contracted physicians including performance, data analysis, budget management and clinical quality monitoring. Acts as the liaison with Initial Clinical Reviewer (ICR) teams and other clinical operations management to ensure clinical delivery is streamlined and consistent across all clinical processes. In conjunction with leadership, this role is held accountable for production cost containment within budget.Essential Functions:-Conducts ongoing activities that organizes the ongoing evaluation of the utilization management program against quality and utilization benchmarks and targets. Identifies opportunities for improvement; organizes and manages cost of care initiatives. Collaborates with leaders including Quality Improvement, Analytics, Finance, Network, and other areas to assure a comprehensive approach to managing quality of care, service, and cost of care. Provides input to Finance regarding patterns of utilization and cost and high cost cases.-Works closely with and provides input for clinical team on program design, policies, procedures, workflows, and correspondence.-Manages production costs containment within budget and adjust staff accordingly.-Continually monitors clinical performance to maximize productivity, customer service and process quality for assigned SBU(s).-Reviews and analyzes daily metrics for physicians to ensure compliance, identify trends and develop action plans to address issues.-Oversees physician performance for schedule adherence and average handle time (AHT) in coordination with workforce planning.-Participates as a member of health plan Quality Committee.-Collects, analyzes and prepares clinical record information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services. Prepares monthly performance reports.-Interacts with multiple stakeholders internally and externally.-Provides training, interpretation and support for Physician Reviewer staff.-Audits and reviews case records, documentation, and telephone interactions against health services quality monitoring standards, regulations, accreditation standards and contract requirements.-Conducts ongoing activities which monitor established quality of care standards for physician services and provides feedback to ensure that targets are met.-Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for vendors, providers, and UM staff. Makes recommendations as to required training based upon audit results.-Monitors and validates internal audit results and/or corrective action plans.-Other duties as assigned. General Job Information TitleSenior Manager Physician Business Management Grade27 Job FamilyMedical Management CountryUnited States of America FLSA StatusUnited States of America (Exempt) Recruiting Start Date10/9/2017 Date Requisition Created10/9/2017 Minimum Qualifications EducationBachelors: Nursing, Bachelors (Required) License and Certifications - Required License and Certifications - PreferredRN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt Other Job Requirements ResponsibilitiesMinimum 5 years in utilization management operations.3 years of regulatory quality assurance experience.Strong working knowledge of Microsoft Office Product Suite, specifically Excel and Access.Willing and able to quickly learn new software applications as needed.Financial/Cost Management experience.Must have experience overseeing contractual performance standards.