* Our client, a fast-growing commercial insurance company, has a need for a program manager to support their growing managed care division* *
Primary purpose: the program manager is responsible for supporting the director of clinical optimization in the implementation, process improvement and optimization of ancillary clinical programsThese programs may include pharmacy, networks (mpn, hcn, obn), dme, pt, diagnostics, and other medical interventionsThis role will also be responsible for analytic measurement and improvement of medical management of their assigned programsThis role will achieve outcomes by focusing on clinical operations, development of new programs to support organizational vision, and cost savings. * * Responsibilities
Monitor analyze and trend clinical program data to assist the director of clinical optimization in the development, implementation and driving of key initiatives for ancillary clinical programs (pharmacy, networks (mpn, hcn, obn), dme, pt, dx).
Optimize clinical programs for nurse and adjuster efficiency, injured employee experience and claim outcome.
Manage day to day issues with clinical program management interfacing with vendors and internal staff
Potential to serve as a business resource for medical analytic needs
Identifies best practices and trends in the industry, participates in evaluating new and emerging technologies and treatments to determine possible incorporation into clinical ancillary program
Participate in office managed care and clinical operational reviews
Manages project development/enhancements through coordination with wc operations
Minimum b.sOr b.aDegree
Minimum 3 years of managing projects and vendor relationships.