Clinical Utilization Management
7 months ago
**Clinical Benchmarking and Best Practices Analytics**
- Direct the integration of clinical data from multiple sources, ensuring comprehensive and strategic analysis. Including electronic health records, patient outcomes, and operational metrics
- Lead collaboration with IT for enhanced data integrity and analytics capabilities.
- Champion the development and implementation of innovative clinical benchmarking metrics
**Internal Utilization Management &**Telemedicine Efficiency**
- Develop and implement advanced measures for telemedicine outcomes, setting industry-leading standards. Including patient outcomes, referral pattetn, prescritptions and follow-up care
- Report the ouctomes against peer groups that effectively measure and improve telemedicine outcomes.
- Report and enhance feedback mechanisms for medical teams, focusing on strategic improvements and high-impact interventions.
- Drive initiatives for significant improvement in telemedicine efficiency and patient care
**Partner Provider Collaboration**
- Lead strategic collaboration in utilization review, aligning services with partner providers
- Initiate and manage high-level feedback loops for continuous improvement in provider collaboration.
- Lead on opportunities for positive provider opportunities and interventions where necessary ensuring delivery of the opprtuinty
- Utilize advanced analytics to optimize provider behavior and performance based on utilization guidelines
**Cost-effectiveness Analytics**
- Integrate cutting-edge cost-effectiveness strategies into utilization reviews for optimal resource allocation.
- Lead cross-functional teams in validating and improving commercial viability of care pathways.
- Spearhead major collaborative projects with a focus on financial impact and quality enhancement
**Leadership Capabilities**
- Ensure and facilitate goal setting manage and constantly review individual performance.
- Provide regular feedback, coaching and development.
- Motivate, empower and enable direct reports by providing the necessary tools and support required to achieve the organizational development objectives.
- Providing leadership and on-going training and development to create a positive team environment.
- Manage transformation and adaptation of team to new service delivery modules.
- Provide leadership, professional guidance and directions to the assigned team members.
- Preparing KPIs for the team performance.
- Build the capabilities of the team members
**Skills**:
- Data visualization tools and Analytical skills.
- Problem-solving skills.
- Communication and presentation skills.
- Leadership skills
**Education**:
Bachelor's/Master's degree medical, healthcare management or healthcare informatics
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