Oversee and lead the inpatient management and related authorization management operations for Commercial and Public Plans (MassHealth, Unify and QHP) products, with potential to lead other division’s inpatient management.
* RN with unrestricted license preferred. BS / BSN or equivalent with Master’s degree preferred. Candidates with demonstrated success within health plan/healthcare operations or administration will be considered
* Ideal candidate will have extensive, relevant inpatient and/or medical management experience with a strong operations background
* Experience in managed care systems required
* Certification in Utilization Management beneficial yet not required.
* 7-10 years of progressive and responsible operations experience in managed care and/or health plan systems, at least four (4) of which is at management level.
* Experience with operations of commercial (fully funded and self funded), exchange, Medicaid and Medicare products required.
* Must have a proven ability to achieve goals and deliver “bottom line” results.
* Excellent working knowledge of managed care operations and business processes is essential, with key expertise in the areas of inpatient management and proven competence in directing operational compliance with CMS regulatory and NCQA, URAC or DOI requirements.
* Proven ability to successfully lead staff is required.