Job Details

Description

1. Utilize project management techniques to lead projects and business analysts to coordinate focused medical review projects as assigned. Document and present relative data and recommendations to management and/or oversight committees. Collaborate to implement strategies to improve quality outcomes and control healthcare cost trend in alignment with corporate initiatives.
2. Conduct analysis to understand utilization trends and recommend improvements to promote appropriate utilization of medical services and effective management of clinical costs. Collaborate with reporting SMEs to create reports to reflect impact of UM programs as demonstrated by direct cost savings and/or changes in provider behavior.
3. Lead cross-functional teams, including but not limited to HMSA staff and external community providers, to support utilization and cost management strategies. Engage stakeholders and make recommendations for department/division/corporate action to support priorities and initiatives.
4. Create and maintain policy, procedure, and desktop instruction documentation. Assist with education and training to HMSA staff and providers regarding Medical Management activities/projects and seek input and cooperation for the development of new programs.
5. Develop and maintain collaborative relationships with a variety of providers and outside agencies to support corporate initiatives. Represent manager in meetings or on special assignments and manage escalated issues at management request.
6. Perform additional duties as assigned.

Qualifications

1. Bachelor's degree and four years of prior work experience in related health care or insurance industry, or combination of education and work experience.
2. Project management skills.
3. Knowledge of project management methods and utilization management activities.
4. Intermediate working knowledge of Microsoft Office applications, including but not limited to Word, Excel, Outlook, and PowerPoint.