Director, Medical Management Operations

Location: Tempe, AZ
Job Description
Position Purpose: Lead Medical Management process improvement initiatives to reduce medical costs, reduce administrative costs, and improve member quality.
  • Assist Medical Management clinical leadership team to establish baseline and target metrics for key business/functional processes
  • Develop and analyze reports across multiple systems to analyze key business drivers and trends in order to develop appropriate mitigation initiatives
  • Collaborate and provide analytical support to Medical Management clinical leadership to facilitate the development, implementation, and evaluation of performance improvement initiatives.
  • Develop processes to increase effectiveness and efficiency, while ensuring compliance with NCQA and contract requirements
  • Lead end to end process evaluation from medical management processes to associated claims payment
  • Develop and facilitate implementation of business processes to leverage technology to increase effectiveness and efficiency; integrating multiple systems to maximize outcomes
  • Develop and implement a consistent methodology to evaluate pilots, processes, and programs
  • Provide leadership and direction to Preauthorization Workforce Management team
  • Bachelor's degree in Nursing, related field, or equivalent experience. Master’s degree preferred.
  • 7+ years of related medical management, operations, analysis, and managed care experience.
  • Advanced knowledge of Excel and Access.
  • Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.  
April A. Estes
Senior Recruiter
720-439-2609 Direct
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