Oversee medical management operations in the health plans. Ensure all Health Plans attain annual health benefits ratio (HBR) targets. Implement and evaluate new and existing projects and processes developed by corporate medical management. Assist in measuring the impact and outcomes of medical management initiatives.

Knowledge/Experience
Bachelor's degree in related field. Master’s degree preferred. 8-10 years of related medical management experience. Analytical skills and Six Sigma experience preferred. Nursing degree preferred.

Position Responsibilities:

• Direct the execution of corporate medical management projects and initiatives.

• Evaluate the effectiveness of medical management processes in the health plans.

• Develop and implement clear communication strategies with health plan medical management.

• Assist in measuring the impact and outcomes of medical management initiatives.

• Work closely with health plan medical management to prioritize projects and resources.

• Work with the Chief Medical Officer to identify medical trends and develop appropriate medical management processes to respond.

• Analyze data, in conjunction with corporate and health plan financial analysis resources, to inform medical management business decisions.