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VP, Health Services - Medical Management

Company: Job Juncture
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.
 
     Incredible growth opportunities and perks for this executive role
                GENEROUS relocation & competitive compensation.
 
 ** We are seeking an experienced leader with a proven background in an MCO/health plan/ACO. 
 
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.
 
Qualifications:
- 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 REQUIRED.

Keywords: Job Juncture, Columbia , VP, Health Services - Medical Management, Executive , Columbia, South Carolina

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