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RN - Vice President - Medical Management

Company: MMS Group
Location: Columbia
Posted on: July 14, 2019

Job Description:

VP Medical Management - Health Services South Carolina VP will be a part of strong collaborative leadership team with the opportunity to be a key strategist in this market We are seeking an experienced leader with a proven background in an MCO health plan ACO Incredible growth opportunities and perks for this executive role GENEROUS relocation competitive compensation Direct and coordinate the medical management quality improvement and credentialing functions for the SC market establishing the strategic vision and policies and procedures for the entire medical management team 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 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 Strong Leadership skills with succession planning experience Ability to lead both in person and remote direct reports Current nursing license REQUIRE

Keywords: MMS Group, Columbia , RN - Vice President - Medical Management, Executive , Columbia, South Carolina

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