Manager I – Medical Management

Role Overview

• manage a team of clinicians charged with promoting quality member outcomes
• optimize member benefits
• promote effective use of resources
• ensures adherence to medical policy and member benefits in providing medically appropriate service
• authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services
• appropriateness of treatment setting by utilizing applicable medical policy and industry standards
• steering members to appropriate providers, programs or community resources
• applies clinical knowledge to work with facilities and providers for care-coordination
• managing appeals for services denied
• hiring, training, coaching, counseling, and evaluating performance of direct reports

Requirements

• Requires a HS diploma or equivalent
• minimum of 5 years acute care clinical experience
• current, active, valid unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources