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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
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Updated: 8/4/2022 10:14:03 AM
Job Contact:
Barb Nash
434 947-4463
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