Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Medical Director,Utilization Management for our Wallingford, CT, office.
Responsible for oversight and management of Medical Management staff, medical reviewers and consultants. Provides clinical expertise in support of medical management programs to promote the delivery of high quality, cost-effective medical care to persons enrolled in the Connecticut Medical Assistance Program (CMAP).
Assists in hiring, supervises and develops Medical Management staff and consulting medical reviewers.
Monitors regular reports on productivity and review outcomes.
Regularly examines sample determination reviews for quality and accuracy of documentation.
Assists in developing action plans to address patterns of care of outlier providers, and care plans of specific members as needed.
Serves as a medical and business leader and contact for participating CMAP providers regarding utilization patterns and questions on determinations, CHNCT Medical Management and Utilization Management personnel, regulatory agencies and the Connecticut Department of Social Services.
Board-certified Primary Care Physician preferred (IM, FP or Peds)
7 to 10 years post licensure clinical experience. Three or more years of experience in Utilization Management (UM), Case Management (CM), and Disease Management (DM). Experience in a managed care environment is a plus. Additional training or experience in HIT, HIE, or EHR preferred. Experience in leading a team performing clinical appeals review, audits, policy development, oversight of reports related to UM department, integration of Corporate practices into operational processes.
CHNCT is an equal opportunity, affirmative action employer m/f/d/v and proud of the diversity of our workforce.
Internal Number: CHN01
About Community Health Network of Connecticut, Inc.
Community Health Network of Connecticut, Inc. (CHNCT) is a 501(c) 4 not-for-profit health plan. CHNCT was founded in 1995 by federally qualified health centers who sought to bring non-profit oversight to Medicaid managed care in Connecticut.
CHNCT, as a Managed Care Organization for 16 years, served the State of Connecticut’s HUSKY and SAGA program populations. Effective January 1, 2012, CHNCT now functions as the state’s Administrative Services Organization for the HUSKY Health Program.