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.

• 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:

• 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.

About PIH Health

PIH Health is the Communities’ Health and Wellness Partner Our network of highly trained and compassionate physicians, nurses, clinicians, staff and volunteers work tirelessly and collaboratively every day to maintain and enhance the health and wellbeing of every member of our service areas. And when needed, we are here to coordinate care, manage chronic disease, and treat health conditions for the best possible outcomes. We’re a nonprofit, regional healthcare network with three hospitals, numerous outpatient medical offices, 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. Our leadership is dedicated to putting patients first—a cornerstone of our mission, vision and values—as we deliver top-quality healthcare. We serve more than 3.7 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. Why PIH Health? Our culture is built around our core values, which are the guiding principles for everything we do. For over 60 years, PIH Health has maintained a sense of community and a family-like cultur...e where patients are the top priority, and employees and volunteers are proud to be affiliated with such an outstanding organization. PIH Health Hospital - Whittier Our Whittier campus delivers outstanding and compassionate care to patients, every day. Among other awards, PIH Health Hospital - Whittier has been named one of the nation’s 100 Top Hospitals® for the third consecutive year by Truven Health Analytics. PIH Health Hospital in Whittier, CA is located 30 minutes east of Los Angeles, close to the Los Angeles and Orange County border. There are many great communities in which to live that surround the hospital. This means easy access to work, great dining, shopping, entertainment and spectacular beaches. Whatever your passion, you’ll find the right place for it here. PIH Health Hospital - Downey is a nonprofit hospital with a rich, nearly 100-year history of meeting the healthcare needs of its community. The Downey campus is part of the PIH Health comprehensive health network consisting of two hospitals, 18 medical office locations and a host of specialty services. According to US News & World Report, the hospital scores highly in patient safety and orthopedics. With 955 employees, the hospital is the 5th largest employer in the city of Downey.

Show more

Show less

Connections working at PIH Health