ABOUT CONCERTO HEALTH
ConcertoHealth Inc. is the leading provider of specialized primary care and supporting clinical services for complex, frail, elderly, and dual-eligible patients. Operating exclusively in value-based agreements, ConcertoHealth provides high-touch, individualized care for patients, and deploys wraparound clinical resources to extend the reach of primary care practices. This comprehensive medical management solution, elevated by Concerto’s proprietary population health technology, improves overall healthcare quality and patient outcomes, benefitting payers and their provider networks.
Concerto delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. The Concerto name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. Our approach focuses on bringing harmony across the spectrum of a patient’s care, health, and dignity.
The company is headquartered in Irvine, Ca. For more information, please visit: www.concertohealth.com
Concerto Healthcare is looking for a Utilization Management Medical Director to partner with the UM clinical operations team. The UM Medical Director oversees daily utilization management and directs the medical care of our members on behalf of our clients and serves in a supporting role as medical manager and policy advisor to the company and our clients. The UM Medical Director is accountable for and provides professional leadership and direction to the utilization/cost management and clinical quality management functions. Works collaboratively with Market Medical directors and other functions that interface with medical management such as provider relations, member services, benefits and claims management. Assists (as determined by Managing Director of UM in coordination with SVP, Clinical Delivery & Operations) in short and long range program planning, total quality management (quality improvement) and external relationships. Works with Clinical Delivery and Operations leadership to support, and provide assistance and direction in overall medical management effectiveness. Monitors all issues of clinical quality management as it related to UM functions and operates within in the confines of the quality oversight policies and procedures. Collaborates with Concerto Healthcare Market Medical directors around evidence-based practices and medical policies and carries out Concerto Healthcare medical policies.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Population health – collaborative care management leadership
Physician and provider relationship management
Quality of care and service delivery