Medical Cost Management Supervisor

RegularExemptGENERAL DESCRIPTION: The role acts as a liaison between Primary Care Physicians (PCPs) and Independent Physician Associations (IPAs) in the Medical Cost program, handling inquiries and operational issues. Responsible for participating in IPA committees, providing resources to Provider Services, facilitating inter-departmental communication, and supporting project completions. Ensures the timely completion of reports on cost trends and utilization management, while overseeing processes that control and reduce medical expenses. ESSENTIAL FUNCTIONS: Act as a liaison for PCPs and IPAs involved in the Medical Cost program.

Address their questions, suggestions, feedback, and complaints, and clarify or resolve any operational clinical situations related to the PCP workplan. Provide resource information to Provider Services staff, specifically regarding the PCP target list and medical-related issues. Coordinate and maintain effective communication with other departments within the company regarding interventions or requests for information needed to support project completions, requests, and activities related to the unit, as operational needs arise. Support the development and documentation of unit production and quality metrics to monitor, evaluate, and validate the results achieved.

Track and assess the effectiveness of cost management efforts, adjusting as necessary. Ensures that the unit team complies with applicable healthcare cost regulations. Collaborate with the IPA management's Provider Operations Director on agreed-upon clinical initiatives within unit management. Participate in various IPA and physician-related committee activities as requested by management. Assist the company's Stars department in assigned initiatives. ADDITIONAL FUNCTIONS:

Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave following the policies, standards, norms, and procedures of the Company. Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.

May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document. MINIMUM QUALIFICATIONS: Education and Experience: Bachelor’s Degree in Nursing. At least three (3) years of experience in utilization management, clinical management projects or initiatives, and cost control in the Healthcare Industry. At least one (1) year of experience supervising staff. “Proven experience may be replaced by previously established requirements. ”Certifications / Licenses: A valid Nurse & Association Nursing Professionals of Puerto Rico license and registration is required. Other:

Knowledge of healthcare management systems, cost management processes, and local/regional health laws and regulations. Languages: Spanish – Advanced (comprehensive, writing and verbal)English – Advanced (comprehensive, writing and verbal)“Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento”