Job Description

1. Acts as co-lead in dealing with provider groups for all medical practice matters. Developing
the best possible working relationships between iCare and its Accredited Providers (Doctors/Hospitals/Clinics/Wellness Partners)

• Ensures provider network meets strategic goals of managing utilization cost while
  providing high quality healthcare to members of iCare.
• Initiate, coordinate, attend meetings that relate to Provider credentialing and iCare’s
  compliance with regulatory requirements, etc.

2. Oversee the clinic management business/portfolio of iCare and ensure coordination with the
company clinics on utilization management initiatives and appropriate care implementation.

3. Provides when needed medical guidance and interpretation for all utilization management
issues (Prior Authorization, Concurrent Review, Retrospective Review)

• Guide the MSC and HLO team with the Pre-approval and concurrent review of cases
  for proper administration of benefits and appropriate care.
• Provide medical guidance in Claims adjudication as necessary.
• Conduct Utilization Review with specific accounts.
• Evaluation of appropriateness of medical care services utilized by the account
  members.

4. Provides when needed medical guidance and interpretation for all utilization management
issues (Prior Authorization, Concurrent Review, Retrospective Review)

• May function as the Lead Healthcare Professional to cover services including but not
  limited to answering medical/clinical inquiries both internal and external.

5. Co-manage the Medical Provider and Services Division, which may include but is not limited to
interviewing and selection, goal setting, and coaching of staff.

6. Participate and lead in appropriate healthcare programs for clients as necessary.

• Creation of preventive health programs in the corporate setting based on the profile of
  the clients.
• Oversee the implementation and management of the Chronic Disease Management
  Program, Sleep Better Program and other health and wellness initiatives of iCare.