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Director, Healthcare Services

Professional Management Enterprises
Exeter, CA Full Time
POSTED ON 10/5/2022 CLOSED ON 10/25/2022

Job Posting for Director, Healthcare Services at Professional Management Enterprises

Description:

Daily responsibilities are as follows:

  • Directs and oversees the following key
    Healthcare Services functions: utilization management
  • Develops, implements and/or monitors
    standardized protocols for clinical and non-clinical
    team activities to facilitate integrated proactive
    care review and management
  • Develops, performs and promotes
    interdepartmental integration and collaboration to
    enhance clinical services
  • Collaborates with and keeps the Director of
    Healthcare Services informed of operational
    issues, staffing, resources, system and program
    needs and presents solution action plan for issues
  • Facilitates and participates in committees, task
    forces, work groups and multidisciplinary teams as
    needed to promote standardized healthcare
    enterprise wide approach to Utilization Management
    programs
  • Ensures monthly auditing is occurring with
    appropriate follow-up
  • Engaged in clinical training activities and
    outcomes.
Requirements:
  • Candidate MUST possess a California RN license
  • Work PST hours from M-F 8AM-5PM
  • Familiarity with MCG, applying Medicare & healthcare criteria with an understanding of the prior authorization process
  • Candidate MUST possess 5 years of managed care or utilization management experience
    Please be sure to include RN licensure on the resume.
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Salary.com Estimation for Director, Healthcare Services in Exeter, CA
$114,656 to $159,984
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