JOB DESCRIPTION Job Summary
Provides executive level strategy and leadership to the health plan in the development and execution of care management and utilization management programs. Develops clinical practice guidelines and oversees appropriateness and medical necessity of services provided to plan members - targeting improvements in efficiency and satisfaction for members and providers. Partners with executive leadership team to provide cohesive direction towards company goals. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Provides executive strategy, vision and direction to the health plan for the medical affairs function. Provides strategic support for design/implementation/execution for programs related to quality improvement, utilization management, care management, predictive modeling and disease management. Responsible for performa...