Job Description: • 2-minute read •
The Director, Employee Health is responsible for implementing Prime Healthcare Management's employee health strategy on behalf of its owned and managed provider entities in a multi-state environment. Actively evaluate, analyze and standardize our Utilization Management, Claims and Workers Compensation Programs in conjunction with the VP of Employee Health. Help develop data reports and tracking to validate efficiencies. On site at Ontario, Guasti office during work week.
Required Qualification: 1. A minimum of 5 years prior work experience in Medical Management including Utilization Management, Case Management, Disease Management, Authorizations, Appeals, and Claims in a managed care, self-funded or hospital setting is required. 2. Understanding of Workers Compensation process and ability to help drive standardization of system wide performance. 3. Analytical skills with emphasis on utilization of data to drive operational and financial performance. 4. Strong interpersonal skills, problem solving and project/time management essential. 5. Requires a minimum of a Bachelors degree in related business/health/management field. Masters preferred. 6. Ability to work in a complex, rapidly evolving environment with multiple internal and external entities and boundaries 7. Ability to develop presentations to all levels using Microsoft Office applications 8. Demonstrated knowledge of: a. Medical Management including UM, CM, DM, Authorizations, Appeals and Claims b. Contract language c. Work flow analysis and optimization. Tracking to drive performance. d. Education utilizing various electronic means including conference calls and webinars.
Experience: Minimum 5 Years
Job Family: Management Occupations
Occupations: Managers, All Other
Degree Required: Bachelor Or Higher
Degree Preferred: Masters Or Higher
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