Job Description

Job Description

Position Purpose
Perform duties to direct all aspects of compliance functions of the health plan, negotiate and handle the relationship with the Medicaid agency, the insurance agency in the State and delegate entities, aid in formulating and administering organization policies and procedure and participates in business development opportunities for the company.

Job Summary

A dynamic, leading, and national provider of clinical abstraction, analysis, and verification services of the highest quality. Maintaining this quality of service requires focused and committed time and attention. To enable this superior quality, the healthcare organization is seeking a Director of Quality Management to expand its Quality Assurance department.

Job Description

Primary Function

Under the leadership of the Vice President, Health Services is Responsible for the planning, development, implementation and management of the Utilization, Chronic Care and Rapid Response programs. Monitors and implements appropriate interventions to assure achieving cost effective and quality outcomes for membership served within approved Medical Budget. Collaborates with the Sr. Medical Director and Vice President, Health Services to evaluate the effectiveness and clinical outcomes of the Chronic Care Improvement Program.