Medical Management Vice President

Milwaukee, WI

Post Date: 08/03/2017 Job ID: 22908 Category: Registered Nurse

Non-Negotiable Requirements:
  • RN
  • CCM (Certified Case Manager)
  • Managed a large team at a Senior Level (Sr. Director and above).
  • 10+ years of clinical nursing, quality improvement, and management experience in a managed care setting.
  • Built a care management model and implemented it.
  • Strong interpersonal and communication skills.
  • Must have the ability to understand how to change the message per the audience.
  • Strong analytic skills and data orientation seeks to understand medical trends and use data when making decisions.

Job Description:
  • Has a high regard for nurse executives.
  • Many opportunities to advance within the organization
  • 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.

Responsibilities:
  • 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.

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.
  • Can demonstrate an ROI on projects or initiatives.

License/Certification:
  • Current state nursing license (RN).

A-Line Staffing Solutions

877-782-3334

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