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Associates Director Medical Management

Job Description

Job Details

Job Title - ASSOC DIRECTOR MED MGMT PCHP
Reports To: Director
Direct Reports: Yes

Job Code: 3883
Exempt: Yes

Mission - Excellent care for life

Vision - To be the most trusted provider of innovative healthcare

Values - Patient Centered Care Drive for Excellence Integrity & Respect Teamwork


Standards of Behavior

Centra employees are expected to model the Standards of Behavior below.
Commitment to Patients & Visitors Serves with compassion. Communicate with clarity. Create a connection. Show Integrity.
Commitment to Colleagues Exceeds expectations. Lead by example.
Be dependable. Build ONE team.


General Summary

This position is responsible for assisting the director with the day-to-day operations of the medical management team. This position has direct oversight of the utilization management and case management teams. The associate director is responsible for the daily operational functions of these two functional areas as well as assisting with process improvement and workflow design for the entire medical management department. This role will assist the director to ensure that the medical management team is a highly-functioning team that bases its success on achieving market-based quality, productivity, and appropriate utilization metrics.


Principle Duties and Responsibilities – Essential Functions

Title and Definition

Assists director with day to day operations of the medical management team.

Responsible for implementation of new projects/strategies related to medical management. Direct oversight of UM and CM management/teams
Ensure that medical management is able to meet regulatory requirements within MM including but not limited to VDH, BOI, NCQA, CMS

Hire, develop and coach clinical teams

Investigate and resolve issues including issue tickets, areas of non-compliance including root cause analysis

Develops and ensures implementation of productivity standards

Ensure adequate system set up to capture metrics and regulatory requirements

Coordinates with internal and external resources as applicable

Assist in and facilities process improvement efforts in support of organizational and department goals

Ability to analyze data and make recommendations for process improvements or clinical program development

Grow and develop staff to ensure their professional development

May perform other duties as assigned or requested and job specifications can be modified or updated at any time


Required Education

Degree / Diploma Program


Educational Requirements
Bachelor’s degree

Preferred Education

Degree / Diploma Program


Educational Requirements

Required Experience

Years of
Experience Type of Experience


Experience Requirements
5+ years of clinical experience
3+ years of leadership experience


Preferred Experience

Years of
Experience Type of Experience


Experience Requirements
Managed care, CMS/NCQA experience

Required Certification & Licensures

Certification / License


Certification/Licensure Requirements
RN license

Preferred Certification & Licensures

Certification / License


Certification/Licensure Requirements

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Centra will engage in the interactive process to determine if reasonable accommodations can be made to enable individuals with disabilities to perform the essential functions of their jobs.



Stands, Walks or Sits - Occasionally up to 1/3 of the time, Frequently from 1/3 to 2/3 of the time and/or Constantly greater than 2/3 or more of the time on the job to complete essential job duties.

Uses hands to finger, handle, feel to - Grip, handle and feel constantly

Reach with hands and arms - Constantly

Stoop, kneel, crouch, crawl - Occasionally up to 1/3 of the time, Frequently from 1/3 to 2/3 of the time, and/or Constantly greater than 2/3 or more of the time on the job to complete essential job duties.

Forward Bending - Occasionally up to 1/3 of the time, Frequently from 1/3 to 2/3 of the time, and/or Constantly greater than 2/3 or more of the time on the job to complete essential job duties.

Climb stairs - Occasionally up to 1/3 of the time, Frequently from 1/3 to 2/3 of the time, and/or Constantly greater than 2/3 or more of the time on the job to complete essential job duties.

Climb ladder - Occasionally up to 1/3 of the time, Frequently from 1/3 to 2/3 of the time and/or Constantly greater than 2/3 or more of the time on the job to complete essential job duties.


Weight Demands -

Activity / Frequency

Lift/Carry up to 10 lbs / Frequently - from 1/3 to 2/3 of the time
Lift/Carry up to 25 lbs / Occasionally - Up to 1/3 of the time
Lift//Carry up to 50 lbs / Never (N/A)
Lift/Carry up to 100 lbs * / Never (N/A)
Lift/Carry more than 100 lbs * / Never (N/A)

* Only with Assistance

Specific Demands Not Listed:

Vision Requirements

Close Vision
clear vision at 20 inches or less

Distance Vision
clear vision at 20 feet or more

Color Vision
able to identify and distinguish colors (if applicable)


Hearing Requirements

Equipment Alarms
Ability to hear equipment alarms

Instructions
Ability to hear instructions from physician and staff

Patients
Ability to hear a patient call


Noise Level -

Noise Level
Moderate Noise


Work Environment

Some positions may entail the following work environments:
Wet, humid (non-weather)
Extreme cold (non-weather)
Extreme heat (non-weather)
Outdoor conditions
Near moving mechanical parts
Fumes/air-borne particles
Toxic/caustic chemicals
Risk of electric shock

If these environments are a factor of your work environment characteristics, they will be considered an essential function of this job.


Disclaimer Statement

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Time:  Full time
Salary:  Salary
Category:  Administration

Updated: 8/4/2022 10:14:03 AM

Job Contact:
Barb Nash
434 947-4463

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2316 Atherholt Road
Lynchburg, VA 24501

434 947-4463