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.
- 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.