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Manager- Medical Management

Company: Government Employees Health Association
Location: Lees Summit
Posted on: November 25, 2018

Job Description:

GEHA is a leader in health services for federal employees and related customers, serving our chosen markets with low-cost offerings and best-in-class customer care, sustained by a nimble and efficient organization.Manages Medical Management Department and is responsible for developing, modifying and implementing policies and procedures within area of responsibility. Work group may have multiple types of work being performed within the team so types of supervision required is unique and personalized for each person with separate projects/work being performed.SKILLS

  • Work is planned in the mid-range time horizon and is focused on establishing policy and procedures for own work group or for other work groups as it relates to responsibility.
  • Responsible for employee selection, performance and disciplinary decisions and may help with lower level management hiring decisions.
  • Makes decisions on work processes and priorities for Medical Management Team. Project success/Work decisions measured on major project milestone.
  • Establishes, and is accountable for, functional policies, processes and objectives for department.
  • Work includes influencing other department management on issues where guidelines or general understanding of company positioning already exists (e.g., negotiating with vendors, standard contact with outside professionals or dealing with regulatory agencies on routine matters)
  • May negotiate with vendors on contract terms.
  • Manage a group who has unique projects that are not similar in nature and supervision requires more personalization of guidance and goals for each team member. Minimum Requirements
    • Requires a Bachelor's degree in Nursing(120 credit hours) from an accredited college/university
    • Additional relevant experience may be considered in lieu of education.
    • Requires three - five years of managerial experience along with experience in the discipline to be managed.
    • Current Registered Nurse Licensure in Missouri or Kansas
    • Requires strong analytic and problem solving capabilities and the ability to identify solutions and recommendations that effectively address business and control needs along with how to train and guide others in this area.
    • Requires the ability to multi-task effectively, responding to changing business priorities and deadlines.
    • Requires the ability to work collaboratively with team members across multiple divisions and departments.
    • Requires a proven record of meeting commitments and achieving goals through the encouragement, guidance and influencing of others.
    • Requires a self-starter personality.
    • Requires highly effective verbal, written and interpersonal communication skills.
    • Requires flexibility and willingness to work with a wide range of personalities on a variety of projects while prioritizing effectively.
    • Requires working knowledge of Microsoft Office applications.
    • Requires some local travel. Preferred Qualifications
      • Master's Degree in Nursing, Health Administration/Public Health, Biostatistics
      • Case Management Certification from a national case management organization or Certified Professional in Healthcare Quality or Utilization Management.
      • Experience participating in direct utilization management activities in a health plan setting
      • Familiarity/experience with accreditation by NCQA, URAC and/or AAAHC
      • Familiarity or experience with clinical policy interpretation and use of evidence-based resources
      • Familiarity with CPT and ICD-10 coding GEHA is an Equal Opportunity Employer. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. Our company's corporate headquarters is located in Lee's Summit near Douglas Rd and I-470 with a total of five locations in the Kansas City metropolitan area.

        Keywords: Government Employees Health Association, Lee's Summit , Manager- Medical Management, Healthcare , Lees Summit, Missouri

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