Job Description

MCMI is responsible for managing Maryland Physician Care’s (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996 and is proud to be celebrating its 25th anniversary. With over 230,000 members, MPC consistently has been one of the third largest Medicaid managed care organizations in MD.

• WHILE THE POSITION IS REMOTE, THE INCUMBENT MUST HAVE A MARYLAND RN LICENSURE AND ABLE TO COMMUTE TO THE LINTHICUM, MARYLAND OFFICE AS NEEDED.
• ALL NEW EMPLOYEES MUST BE FULLY VACCINATED.

This position is responsible for the planning, development, organization and evaluation of functions for concurrent review programs. Concurrent review is one of the processes within medical management to evaluate while a member is hospitalized the medical necessity of the admission and the appropriateness of the services provided. The process is intended to reduce occurrences of over- under- or misuse of services to improve the member’s inpatient care outcomes and to ensure the cost-effectiveness of the services.

Provide oversight of concurrent review process.

• Responsible for recruitment and selection of appropriate staff and prepares timely employee performance evaluations.
• Prepares reports of utilization indicators and activities for committees and senior management.
• Prepares annual budget and operates within approved budget.
• Serves as an active participant in clinical committees such as utilization management, quality management and pharmacy and therapeutics committees.
• Serves as a resource for health plan information and helps to integrate concurrent review function throughout the health plan.
• Assists in the annual development of measurable goals for inpatient utilization review programs based on data form utilization reports, quality indicators, survey results, regulatory agencies and plan initiatives and priorities. Implement ongoing development and education of concurrent review staff.

Knowledge and Skills:

• Excellent communication skills, both written and verbal.
• Good interpersonal skills including tact and the ability to be a team player.
• Demonstrated skills for presentations and training before small and large groups.
• Knowledge of local health care delivery system.
• Strong problem solving, organizational and time management skills with the ability to work in a fast-paced environment.
• The ability to successfully utilize Microsoft Office suite and common computer and office hardware is necessary.

Education and Work Experience:

• Current Maryland RN license
• Bachelor of Science in Nursing or Health Care Administration and/or health related field (BSN preferred). Master’s or MBA preferred.
• Three to five years of progressively responsible health care administrative experience, preferably within the managed care industry.
• Minimum of five years of management and supervisory experience with a minimum of three years of clinical experience.

Company Description

Friendly startup and fast paced environment, schedule flexibility competitive pay