Opportunity Snapshot

As our Project Manager, you will build and lead a team that will administer a Radiology Prior Authorization Program for Idaho's Medicaid program. If your specialty is radiology and you have an interest in utilization review, you will find this role rewarding on a personal and professional level. . .

Professional rewards. . .
As manager of this new team, will enjoy a "best of both worlds" career opportunity: the clinical sophistication of Permedion, a recognized leader in the assessment of healthcare services, and the resources and stability of Health Management Services (HMS), our parent corporation, recently ranked #3 on Fortune's 2009 FSB 100 list of America's fastest growing small public companies.

Personal satisfaction. . .
You believe in utilization review and that the appropriate allocation of healthcare resources is critical to improving the quality and effectiveness of our healthcare system. Here, you can impact the quality of care for patients in Idaho, ensuring that radiology services are deployed in the most efficient and effective manner.

Our Requirements

• Experience managing a team and/or project (at least two years).
• Experience as a Radiology Technologist. A current certification is strongly preferred, but not required.
  • Imaging services coding and review experience preferred.
  • Knowledge in and successful application of basic level of health care data analysis and clinical review.
• Customer service, provider relations or client management experience.
• Ability to become familiar with State laws and practices as it relates to: Imaging reimbursement, outpatient reimbursement, Medical records requests, and overpayment recovery preferred.
• Ability to travel 10-20% of the time (typically one trip per month to Idaho).

Your Rewards

Additional rewards include:

• Being in the right company at the right time -- Medicaid and Medicare budgets are growing (CMS predicts current Medicare/Medicaid spending levels to double by 2015) and, with billions of dollars at stake, there is a strong emphasis among policy leaders (and the voting public) on cost containment and payment accuracy. Permedion and HMS are taking advantage of this climate to drive solid growth. In addition to posting double-digit growth year over year since 2001, HMS is successfully expanding into new markets.
• Exposure to clinical sophistication through continuous improvement -- our URAC accreditation requires that we maintain continuous organizational improvement processes, and we never stop learning and growing. This spirit has enabled us to achieve industry recognition for our expertise. For example, we are designated by the Centers for Medicare and Medicaid Services (CMS) as one of eight Qualified Independent Contractors (QIC) in the US, meaning CMS acknowledges that we have the expertise and capabilities to perform appeals of Medicare claims between the carrier and Administrative Law Judge levels.
• Excellent compensation -- in addition to a competitive salary, we offer a comprehensive benefits package that includes all you would expect plus a few pleasant surprises, such as a 401(k) plan with generous employer match, flexible spending plans, and much more.

More About Your Role

In January 2010, the State of Idaho will award the contract to provide a Radiology Prior Authorization Program for its Medicaid program. You will join us prior to the contract award date and play a critical role in hiring and training the team as we transition quickly from planning to implementation to production mode.

You will report to a Contract Administrator and have the support of a designated medical director (a Board Certified Radiologist) for this project. Your time-critical first objective will be to recruit and train a team of seven Intake Coordinators, and two to three Nurse Reviewers ensuring that we are ready to start delivering on our contract commitments on our about February 1, 2010

You will establish performance metrics and quality control standards for the team as well as each member. As you might expect, in the early stages you'll invest a good deal of your time in training. Once the program and your team are up and running, you will supervise them, act as a resource to resolve issues, and drive continuous quality improvement efforts.

This is a client-facing role and you'll have regular interaction with our key contacts, including weekly phone calls and monthly in-person meetings. The goal of these meetings, of course, will be to ensure client satisfaction and manage expectations. In addition, we'll look to you to keep an eye out for opportunities to expand the current contract or provide services in other areas. To that end, you may become our "subject matter expert" for implementing similar prior authorization programs, and you may assist the organization with future proposals and strategic planning.

Keys to Success

To excel in this role you will demonstrate the initiative characteristic of a skilled leader, but balance that resourcefulness with the good judgment of a clinician. As a leader, you will bring a hands-on, action-oriented approach to ensuring delivery to schedule and performance expectations. You will also need to be:

• An excellent communicator -- your responsibilities will cover the gamut from contributing technical information to proposals to making client presentations.
• A systems thinker -- adept at "seeing" all of the moving parts of a system, you will think beyond our current processes and implement efficiencies that increase margins but maintain (or better yet, improve!) quality.

If this sounds like the right mix of challenge and opportunity for you, and you meet the required qualifications, we want to hear from you!

Who We Are

Permedion provides external medical peer reviews and independent health care review services for government agencies and large health care providers, helping them control escalating health care costs while providing appropriate medical care. Our three primary areas of service are health care quality measurement and improvement, data analysis and management, and independent medical review.

With a unique combination of statistical and clinical expertise, Permedion works with government agencies, managed care organizations, and other payors to review, measure and improve health care quality. Our staff includes physicians, nurses, epidemiologists and data analysts, systems experts, and health administration experts. Our partners and customers include health plans, physician groups, government agencies, and professional associations.

Permedion is a wholly owned subsidiary of Health Management Systems, Inc. (HMS), providing clinical expertise to all HMS service lines. HMS is an industry leader in the coordination of program integrity and benefits services for government healthcare programs. Since 1985 HMS has focused exclusively on the healthcare industry and during that time we have partnered with more than 45 Medicaid agencies, other state health programs, and more than 50 government-sponsored healthcare plans to help them recover billions of dollars, and save billions more through cost avoidance. Our portfolio of services includes coordination of benefits for Medicaid-Medicare, third-party liability, and pharmacy services; overpayment recovery; provider audits; medical support enforcement; and more.