Directs medical management projects and initiatives related to case management, utilization management, ENCC and clinical pharmacy. Identifies medical management initiatives, develops strategies and deploys resources in order to reach corporate goals. Assists in evaluating the impact and effectiveness of initiatives. Works closely with health plan medical management to prioritize projects, identify medical trends and develop processes to successfully respond to trends.
Bachelor's degree required.
Current unencumbered Oregon RN license required.
Five (5) years experience in program or project management required. The experience must have included program evaluation responsibility.
Five (5) years supervisory experience required.
Experience or training in disease management, utilization management, case management, clinical pharmacy and managed care required.
Experience or training with computer applications required.
Experience or training in data analysis, problem-solving processes and communication strategies required.
Previous health plan experience preferred.
Experience or training in Medicare, Medicaid and commercial insurance preferred.
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