Job opening in a managed care solutions company, has a need for a VP of Medical Management to join their team.
Job Summary:
- Perform duties to direct and coordinate the medical management, quality improvement and credentialing functions for the assigned health plan based on, and in support of the company’s strategic plan; establishing the strategic vision and attendant policies and procedures.
- Direct and coordinate activities of department and aid the chief officer of the health plan and appropriate corporate staff in formulating and administering organizational and departmental policies.
- Review analyses of activities, costs, operations and forecast data to determine department progress toward stated goals and objectives.
- Serve as a member of management committees on special studies.
- Administer and ensure compliance with National Committee on Quality Assurance (NCQA) and/or Joint Commission on Accreditation of Healthcare Organization (JACHO) standards as determined for accreditation of the health plan.
- Participate in, attend and plan/coordinate staff, departmental, committee, sub-committee, community, State and other activities, meetings and seminars.
- Participate in provider education and contracting, as necessary.
Qualifications:
Education/Experience:
- Bachelor’s degree in Nursing, related field or equivalent experience.
- 10+ years of clinical nursing, quality improvement, and management experience in a managed care setting.
- Thorough knowledge of a specialized or technical field such as clinical nursing, managed care, and healthcare administration.
- Thorough skills knowledge of quality improvement practices.
- Working knowledge of medical information systems, medical claims payment process, medical terminology and coding, case management practices, managed care, and Medicaid programs.
- Familiarity of National Committee on Quality Assurance (NCQA) accreditation process and standards.
- Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
License/Certification:
- Current state nursing license.
Describe how this position fits in your organization.
This role was created to oversee our Medicaid division specifically. This VP will sit in our Little Rock office full-time. If relocation is necessary for the selected candidate, we will provide a generous relocation package.
What are the 3-4 non-negotiable requirements on this position?
Active RN License without restrictions. 10+ years of clinical nursing, quality improvement, and management experience in a managed care setting. Strong leadership experience. CM and UM experience with Medicaid.
What are the nice-to-have skills?
Previous MCO experience in AR.
What is exciting about this opportunity? Please use this section to describe team and company culture.
This is a new role created specifically to focus on the medical management operations for AR’s Medicaid membership. This role does have the possibility of growing locally but the company also has Corporate roles that could provide additional growth opportunities beyond this VP level.
Competitive Salary Range!
How to apply for the VP of Medical Management Job: contact tinaroberts@contactjc.com or tinaroberts@toprecruiterweb.onmicrosoft.com
Tina Roberts
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