Utilization Manager Jobs in Covington, LA (NOW HIRING)

Over $300K in Potential Compensation
AbsoluteCare is seeking a dynamic physician leader to put the principles of population health into action for our medically complex & socially vulnerable members. Oftentimes, due to the effects of trauma and poverty, a significant portion of our population suffer from infectious diseases – including HIV, Hepatitis C, and complex wound infections. Through our integrated care teams, including physicians, advanced practice practitioners, nurse care managers, social workers, behavioral health therapists, peer counselors, dietitians, pharmacists, and community outreach workers, we transform the lives of our members.
Working within our matrix organization, the Medical Director will collaborate closely with the National Directors of their respective disciplines to implement process improvements, enhance our standards of care, and surpass discipline specific professional practice guidelines in our ambulatory intensive caring unit care model.  As a dyad partner with the Practice Administrator, the Medical Director will be responsible for all the medical center outcomes including utilization, quality outcomes and the overall operation of the medical center and providers. This role is instrumental to our fast-growing organization’s success, and requires a person who exhibits dynamism, humility, clinical acumen, the ability to work collaboratively, and strong leadership skills.

Specific Duties and Responsibilities
Clinical Leader of the Practice:

• Lead the medical center to deliver superb medical care utilizing a comprehensive "one stop shop" in a NCQA certified Patient Centered Medical Home (PCMH) model, along with Complex Care Management.
• Build relationships with and collaborate with health plan medical directors, local hospitals, specialists and other organizations to help meet the outcomes and decrease the fragmentation of care.
• Manage the team to track and meet contractual quality metric goals.
• Use technology and the electronic medical record to the highest capability in order to increase quality initiatives and efficiency within the medical center.
• Participate in multi-disciplinary meetings and recommend treatment alternatives designed to keep patients healthy or resolve on-going clinical issues.
• Working in a dyad model with the Practice Administrator, manage the Medical Staff and other AbsoluteCare team members.
• Collaborate with National Directors across the company to implement process improvements, enhance our standards of care and surpass discipline specific professional practice guidelines in our ambulatory intensive caring unit care model.
• Provide medical guidance to the Medical Staff, reviewing current medical practices and guidelines and implementing best evidence-based practices.
• Implement strategic medical operations and protocols in order to achieve company's contracted goals.
• Evaluate the current medical operations and operations of the entire medical center to ensure compliance and contractual obligations.
• Constantly improve the quality of care and outcomes for AbsoluteCare patients.

Qualifications
The ideal candidate will be an excellent physician, a systems thinker, organized, a clear communicator, technologically savvy, excited to work in an interdisciplinary team, and most of all, mission driven to serve our medically complex and socially vulnerable patient population. A physician leader with the ability to thrive in uncertainty and ambiguity, work without ego, and thoughtfully build successful relationships with team members and our partners is necessary.

• Board certified in Internal Medicine or Family Medicine.
• Licensed physician in the state of practice.
• 4+ years of experience managing Medicare, Medicaid, and commercial populations.
• ACLS certification.
• Ability to treat the acutely ill in an outpatient setting offering hydration, IV antibiotics, wound care, and other services.
• Knowledge of value-based provider programs, utilization management and HEDIS quality measures.
• Long-term interest in AbsoluteCare.

Preferred Qualifications
Infectious Disease training (Board Certification) or AAHIVM certification strongly encouraged.
Advanced degrees (MBA, MPH, MS) or work experiences outside of medicine are a plus.
Working conditions

This job operates in a patient care setting where there is potential exposure to blood, bodily fluids, and infectious materials.  This role routinely uses general office equipment.  Often wear a special uniform, such as a lab coat or surgical scrubs, protective or safety attire, such as gloves and masks.  High patient traffic, close quartered and shared workspace.

Physical requirements

• Ability to communicate clearly and exchange accurate information constantly.
• Ability to remain stationary and/or stand for long periods of time.
• Constantly operates computer, keyboard, copy and fax machine, phone and other general office equipment.

Direct reports

Primary Care Physician, Infectious Disease Physician, Dietician, Health Educator,

All Employees are expected to maintain the security and privacy of all information that is owned by AbsoluteCare or maintained on behalf of the company’s patients, employees, and business partners. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.  This description reflects management’s assignment of essential functions, it does not proscribe or restrict the tasks that may be assigned.  This job description is subject to change at any time.