Director, Medical Management HMS (Texas Residents Only)

The Director, Medical Management is accountable for the leadership, direction, and daily operation of the HMS business while ensuring continuous financial and operational excellence. The Director of Medical Management provides strategic and tactical leadership, counsel, and direction to ensure delivery of high quality and cost-effective care. Additionally, the Director of Medical Management identifies improvement opportunities, monitors performance, and works closely with IPA/MSO Medical Director, Senior Director of MSO and Chief Operating Officer of MSO. The Director, Medical Management is a key member of company’s management team.

This position is for Texas residents only.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

Required Skills

• Able to work autonomously with high level of critical thinking and resourceful
• Self-motivated, high energy, focused individual with a track record of effectively managing a team of clinical and non-clinical staff, achieving results, and taking responsibility for outcomes.
• Thoughtful, persuasive, and decisive leader with excellent listening skills able to integrate input of various constituencies in a highly complex environment and act with resolve, regardless of the circumstances.
• Effective and persuasive communicator and presenter able to express technical details, opinion and organizational viewpoints in an effective manner that builds consensus and drives change.
• Strategic thinker, able to visualize the whole picture while skillfully managing the detail and ensuring integrity for the full range of work products.
• Demonstrated interpersonal, collaborative, and relationship-building skills.
• Strong computer skills and the ability to utilize various report-generating software packages.
• Strong desire to manage, develop and mentor staff.
• Outstanding conceptual, analytical, and problem-solving skills.
• A team player with strong interpersonal and communication skills; track record of developing collaborative and effective working relationships with physicians, clinicians, management, colleagues and peers; ability to motivate, lead and influence others to implement key strategies.

Required Experience

Required:

• Minimum of 3 years of Case Management/Utilization Management or Quality Management experience
• Minimum of 3 years leadership/management experience
• Knowledge and understanding of Utilization Management and Quality Management procedures in a managed care setting including but not limited to: HMO guidelines, criteria, and division of financial responsibility; CMS guidelines; MCG guidelines, and Federal and State regulations.
• Significant experience in leading teams, group facilitation, project management, and building management systems.
• Financial management skills including healthcare budgeting and financing, pricing, revenue optimization, reimbursement and payment models, and cost management.
• Demonstrated experience and success in developing and implementing innovative programs for growth strategies, physician and payer engagement/relationship

Preferred:

• Master’s Degree preferred
• Prior managed care in an IPA, MSO, HMO setting
• Skills in change management, Six Sigma, Lean and/or other continuous performance improvement techniques.