Current Job Opportunities

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 JobTitleCityStateJobType
AR-CT-3952Director, Medical Management OperationsLittle RockAR 
AR-CT-3976Behavioral Health Medical DirectorLittle RockAR 
AR-CT-3977Manager, Medical ManagementLittle Rock  
AZ-CT-3965Chief Behavioral Health Medical Director TucsonAZ 
AZ-CT-3966SR Behavioral Health Medical Director    
CA-CT-3779Director, Medical Management - TWO POSITIONSRancho CordovaCA 
CA-CT-3926Director, Sales Large Group Health Insurance Woodland HillsCA 
CA-CT-3934Vice President, Strategic Provider PartnershipsWoodland HillsCA 
CA-CT-3962Regional Network DirectorOaklandCA 
FL- CT- 3871Medical Director- LTC and Medicare ANY CITYFL 
FL-CT-3791Case Manager II Maitland/OrlandoFL 
FL-CT-3932Director, Provider Payment InnovationsTampaFL 
FL-CT-3958Supervisor, UM Orlando or SUNRISE FL 
FL-CT-3975Behavioral Health Medical Director SunriseFL 
FL-CT-3982VP, Medical ManagementSunriseFL 
FL-CT-3988Director, Quality    
GA-CT-3460Manager, Case MgmtAtlanta GA 
GA-CT-3883Director, Case ManagementAtlantaGA 
GA-CT-3927Manager, Medical Management (Medicare) RN   
GA-CT-3972Behavioral Medical Director Atlanta GA 
 
Job ID:AR-CT-3952
Job Title:
Director, Medical Management Operations
Rate:
Primary Skills:
Description:
Director, Med Mgmt Operations - Little Rock
________________________________________________________
National healthcare enterprise is continuing to grow and expand in Arkansas.   Incredible career growth - great leadership !
 Lead Medical Management process improvement initiatives to reduce medical costs, reduce administrative costs, and improve member quality.
Assist Medical Management clinical leadership team to establish baseline and target metrics for key business/functional processes
Develop and analyze reports across multiple systems to analyze key business drivers and trends in order to develop appropriate mitigation initiatives
Collaborate and provide analytical support to Medical Management clinical leadership to facilitate the development, implementation, and evaluation of performance improvement initiatives.
Develop processes to increase effectiveness and efficiency, while ensuring compliance with NCQA and contract requirements
Lead end to end process evaluation from medical management processes to associated claims payment
Develop and facilitate implementation of business processes to leverage technology to increase effectiveness and efficiency; integrating multiple systems to maximize outcomes
Develop and implement a consistent methodology to evaluate pilots, processes, and programs
Provide leadership and direction to Preauthorization Workforce Management team

Qualifications:
- Bachelor's degree in Nursing, related field, or equivalent experience. Master’s degree preferred.
- 7+ years of related medical management, operations, analysis, and managed care experience.


-Advanced knowledge of Excel and Access. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. Six Sigma experience preferred.
 
    
 
Job ID:AR-CT-3976
Job Title:
Behavioral Health Medical Director
Rate:
Primary Skills:
Description:
Behavioral Health Medical Director - Little Rock
Clinician seeking a purposeful role with the capacity to improve the lives of the underserved will thrive in this organization. 
Newly created role will report to the CMO of this expanding market.
Assist the VP of Clinical Programs to direct and coordinate the physician component of the utilization management functions for the health plan business units.
Provides medical leadership for utilization management activities and medical review activities pertaining to utilization review, quality assurance, medical review of complex, and controversial or experimental medical services such as transplants utilizing the services of consultants

Performs case reviews and appeals for all health plans.

Assists VP of Clinical Programs in planning, establishing goals and policies to improve quality and cost-effectiveness of care and service for members.

Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.

Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.

Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.

Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment

Qualifications:
-MD or DO -Board certification by the American Board of Psychiatry and Neurology. 
Previous experience in an MCO preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred.
Experience treating or managing care for a culturally diverse population preferred.
 The candidate must be an actively practicing physician.


 
 
    
 
Job ID:AR-CT-3977
Job Title:
Manager, Medical Management
Rate:
Primary Skills:
Description:
Manager, Medical Management  - Little Rock, AR
National healthcare enterprise is continuing to grow and expand in Arkansas.   Incredible career growth - great leadership !
 Manager will be responsible for managing a complete program of medical management in accordance to include oversight for the functions of utilization management and case management.Implement changes to medical service functions and performance in relation to company mission, philosophy objectives and policies, as directedManage budgets and forecast for strategic planning and key initiatives. Balance current future needs effectively
Research and incorporate best practices into operationsAssure that Medical Services functions and responsibilities are coordinated with other operating departments of the Plan and Corporate
Responsible for the statistical analysis of utilization dataParticipates in NCQA accreditation of the PlanQualifications:- Bachelor’s degree in Nursing or equivalent experience. - 3+ years of nursing experience, including quality improvement experience in a healthcare environment, preferably in managed care. -Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. -License/Certification: RN license in AR

© 2013-2018 Scout Exchange LLC. All Rights Reserved
 
    
 
Job ID:AZ-CT-3965
Job Title:
Chief Behavioral Health Medical Director
Rate:
Primary Skills:
Description:
Position Purpose: Assist the Vice President of Medical Affairs to direct and coordinate the medical affairs functions for the business unit. Oversee the denials and appeals department. May manage other medical directors. Assume VPMA responsibility in absence of VPMA.
Provide medical leadership for all utilization management, pharmacy, case management, disease management, cost containment, and medical quality improvement activities. Perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Support the effective implementation of performance improvement initiatives for capitated providers.
Assist VPMA in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
Assist the VPMA in the functioning of the physician committees including committee structure, processes, and membership. Oversee the activities of physician advisors and other medical directors. Utilize the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participate in provider network development and new market expansion as appropriate. Participate in provider profiling initiatives. Assist in the development and implementation of physician education with respect to clinical issues and policies.
Identify utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identify clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice by profiling providers in order to improve the quality and cost of care. Interface with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Review claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
Develop alliances with the provider community through the development and implementation of the medical management programs. As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. Represent the business unit at appropriate state committees and other ad hoc committees.
Oversee all aspects of the Appeals and Denials department including implementing budgetary, policy, and personnel decisions for the department.
Qualifications:
Education/Experience: Medical Doctor or Doctor of Osteopathy, board certified in a primary care specialty (Internal Medicine, Family Practice, OB/GYN, Pediatrics or Emergency Medicine). Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. Previous experience within a managed care organization and with Medicaid programs is preferred. Experience treating or managing care for a culturally diverse population preferred.
License/Certification: Board Certification through American Board Medical Specialties
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Employee Status:
Regular
Job Level:
Director/Sr. Director
Job Type:
Regular
Mandatory Recruiter Notes
All agencies must provide the details below within their recruiter notes in order to submit a candidate:
Availability date to start a new role:
Current location of the candidate:
Desired salary:
Will the candidate require visa sponsorship now or in the future:

Due to the recent Pay Equity regulations mandate you are prohibited to share a candidate's current or prior salary details in states the mandate is in effect.


NOT READY
Is Relocation Available?
Yes, nationwide
Is there a bonus structure?
20% or higher
Are you open to sponsorship?
No
This position is:
New Position
Is there a possibility to work remote?
No
Is there equity?
No
Are there flexible work hours?
No
Does this position have direct reports?
No
Who does this position report to?
Chief Medical Director
What are the 3-4 non-negotiable requirements on this position?
* Board Certified * Mental Health Background * AZ licensed * Ready to work in an office M-F.
What are the nice-to-have skills?
Go Getter/computer skills.
What is exciting about this opportunity? Please use this section to describe team and company culture.
Candidate does not have to have Medical Director experience.
 
    
 
Job ID:AZ-CT-3966
Job Title:
SR Behavioral Health Medical Director
Rate:
Primary Skills:
Description:
 
    
 
Job ID:CA-CT-3779
Job Title:
Director, Medical Management - TWO POSITIONS
Rate:
Primary Skills:
Description:
Director, Medical Management - CA - need 2 for new contract!
New region opening and it's a GREAT opportunity to bring your own ideas and creativity.
Strong leaderhsip support of programs of care management.  Director will work closely with the Medical Informatics team to identify trends that need to be addressed with program management.
- Responsible for Care Management clinical inter-rater reliability and monitoring important aspects of care.
- Effectively manages the activities of staff providing leadership and guidance.
•  Interviews, recommends for hire, and evaluates staff, and counsels and confronts unsatisfactory performance promptly and fairly and administers corrective action.
•  Identifies department goals and objectives, develops and communicates action plans through regular staff meetings and other communications, uses team approach to problem solve and sets clear expectations.
•  Identifies training needs and develops and participates in staff training. Provides a challenging and supportive environment and delegates appropriately. Seeks additional training opportunities through outside sources.
•  Analyzes work plans developed by subordinate managers and monitors the status of their work in relation to the overall schedule requirements.
•  Develops monitoring systems and measurements and exhibits a customer service philosophy.
•  Manages statistical and qualitative information concerning patient outcomes and physician/hospital practice patterns in accordance with health plans’ utilization standards.
•  Intervenes with hospital or physician contractors to examine cases to ensure methods for meeting these utilization standards while maintaining precedent for quality of case standards.
•  Determines and enforces - through functional groups - medical management requirements in accordance with real company needs, based on current regulations and state-of-the art product development.
•  Organizes and promotes medical management functions.
•  Evaluates and develops improved techniques for the control of quality and reliability.
•  Plans and develops improved techniques for the control of health care costs.
•  Plans, on a quarterly or longer basis, the overall use of resources.
•  Provides information and advice to higher level management related to medical management.
Qualifications:
Education/Experience: Bachelor’s degree in Nursing or equivalent required; Master’s degree in Health Services Administration or equivalent desired. Five years clinical experience in an acute care setting. Four years experience in quality management/improvement in a health care setting. Two years work experience in a managed care environment. Five years management experience in a health care setting. Three years medical management experience in an HMO setting desired
License/Certification: Must have and maintain current valid and unrestricted Registered Nursing (RN) license. Valid state driver’s license
 
    
 
Job ID:CA-CT-3926
Job Title:
Director, Sales Large Group Health Insurance
Rate:
Primary Skills:
Description:
 
    
 
Job ID:CA-CT-3934
Job Title:
Vice President, Strategic Provider Partnerships
Rate:
Primary Skills:
Description:
Vice President, Strategic Provider Partnerships - CA
Responsible for working with regional and corporate personnel to identify, build and implement business strategies that support this healthcare enterprise's provider network and product development initiatives.
Proven leader will work closely with most other departments to facilitate process improvement and strategic initiatives.
VP will direct and supervises staff in the development and implementation of Strategic Provider Partnership Initiatives.

VP develops, recommends and implements cross-functional plans and activities to achieve strategic initiatives; communicates insights, progress of challenges and presents resolution scenarios.

Tracks/reports status on strategic partnerships, risk adjustment, tailored network development and other activities to leadership teams.

Builds and maintains effective working relationships with cross-functional leaders and teams in order to identify, explore, present and implement business opportunities.

Maintains a service-oriented atmosphere within the Network Management department.

Ensures that team’s activities and business operations are carried out in compliance with company policies, and local, state and federal regulations and internal requirements.

Responsible for associates’ work climate and provides leadership for initiatives to make the department a great place to work.

This leader will be charged with advancing our goals to:
·      Better support the provider community by simplifying and improving provider experience
·       Leveraging analytics and practice transformation to improve performance
·       Collaborating with other leaders to redesign the delivery system and ensure our model of care supports provider needs
·       Supporting other strategic initiatives enabling providers to effectively serve our members.
 
Bachelor’s degree in business or health related field required
MBA preferred.
10+ years  managed care experience in a health plan, MSO, MCO, ACO is desired. May consider someone with provider managed care department experience with CA market experience.
 
    
 
Job ID:CA-CT-3962
Job Title:
Regional Network Director
Rate:
Primary Skills:
Description:
Regional Network Director  -Oakland, CA
Reporting to the VP, Regional Director will "own" the Northern CA market to develop provider network strategies; negotiates, implements and maintains provider networks that consists of multiple or complex provider contracts in the region.
-Manages the activities of regional provider staff responsible for servicing the network, consistent with company goals, policies and objectives.
-Directs and manages networks (market, state or national based) and works on corporate projects.
-Ensures that organization is in compliance with federal, state and regulatory requirements.
-Develops goals, work plans and schedules for regional provider staff and ensures that they are executed.
-Responsible for the day-to-day supervision and monitoring of contracting staff and negotiations, provider services administration and operation for local region, statewide and/or national providers.
-Responsible and held accountable that overall region/statewide/national provider databases are maintained current and accurate, and information is presented internally and externally in a timely and professional manner.

-Plans and coordinates the addition of health care providers within an assigned geographical area; leads the negotiations of annual contracts within the region or statewide; monitors the performance of providers, and within accepted practices, has authority to finalize and close contract negotiations.
-Responsible for accurate and timely data analysis, presentations and provider education.

-Monitors capacity of existing medical groups, negotiates for additional capacity or explores other alternatives.
-Determines which groups need assistance in managing programs, and assists them in developing corrective action plans.
- Responsible for accurate analysis and assessments of quality of care and access by patients.
-Facilitates and assists with problem resolution related to numerous entities including, but not limited to, providers, marketing, claims, member relations and employer groups.
-Ensures that staff is adequately trained in all skills necessary and appropriate to their job, including but not limited to the following areas: contract negotiation and/or interpretation and clarification, marketing programs,  products, customer service, provider network management and project management.
-Provides leadership and direction to corporate and statewide projects, and ongoing regional responsibilities.

-Coordinates with Sales and Marketing on programs for region and/or statewide providers. 
 
-Consults with Organizational Effectiveness on human resources related issues for the region, including but not limited to selection, conflict resolution, staff development, and performance evaluations.

-Significant budget responsibilities and impacts. Monitoring and meeting budgetary goals on a regular basis.
Qualifications:
- Bachelor’s degree in Health Services, Health Care/Hospital
Master’s degree preferred.

- 5+ years extensive provider network management/health care management experience
- 4+ progressive network contract negotiation experience.
- STRONG preference for contracting experience in Northern CA
- Strong project management experience
- Supervisory/leadership experience required
 
    
 
Job ID:FL- CT- 3871
Job Title:
Medical Director- LTC and Medicare
Rate:
Primary Skills:
Description:
...MEDICAL DIRECTOR- LTC and
Medicare - FLORIDA! 
(Choose Sunrise, Tampa, Orlando or Jacksonville)


..........National health plan is growing and diversifying in the FLORIDA
market.  A physician seeking a purposeful career with an opportunity to
make a difference in the quality of care and access to care will thrive in this
role.




- Medical Director will collaborate with the Chief Medical Director to
direct and coordinate the medical management, quality improvement and
credentialing functions for the FL health plan.  Provides medical
leadership of all for UM, cost containment, and medical QI activities.  Be
part of planning and establishing goals and policies to improve quality and
cost-effectiveness of care and service for members. Performs medical review
activities pertaining to utilization review, quality assurance, and medical
review of complex, controversial, or experimental medical services. Supports
effective implementation of performance improvement initiatives for capitated
providers.




-  Participates with the Chief MD in the functioning of the physician
committees and oversees the activities of physician advisors. Utilizes the
services of medical and pharmacy consultants for reviewing complex cases and
medical necessity appeals. Participates in provider network development and new
market expansion as appropriate. Assists in the development and implementation
of physician education with respect to clinical issues and policies.




-  Identifies utilization review studies and evaluates adverse trends
in utilization of medical services, unusual provider practice patterns, and
adequacy of benefit/payment components. Identifies clinical quality improvement
studies to assist in reducing unwarranted variation in clinical practice in
order to improve the quality and cost of care. Interfaces with physicians and
other providers in order to facilitate implementation of recommendations to
providers that would improve utilization and health care quality. Reviews
claims involving complex, controversial, or unusual or new services in order to
determine medical necessity and appropriate payment.




•  Develops alliances with the provider community through the
development and implementation of the medical management programs. As needed, may
represent the business unit before various publics both locally and nationally
on medical philosophy, policies, and related issues. Represents the business
unit at appropriate state committees and other ad hoc committees






Requirements;




-  MD or DO - Board certified preferable in a primary care specialty


- The candidate must be an actively practicing physician.


- Previous experience within an MCO and/or conducting medical reviews is
preferred.


- Experience treating or managing care for a culturally diverse population
preferred.
- Willing to practice clinically 1/2 day per week and work 4 1/2 days in the office
-Prefer Long-term care, geriatric, Family Practice or Internal Medicine experience
 
    
 
Job ID:FL-CT-3791
Job Title:
Case Manager II
Rate:
Primary Skills:
Description:
CARE MANAGER II - Maitland/Orlando - office -based 
Make a positive impact on members lives by helping them improve their health and access to care.
Great opportunity to join a new team rolling out a new product in Florida.  Supportive manager and unlimited growth-  no "on call" or weekends!  

RN will assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.

This may include assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
Provide patient and provider education
Facilitate member access to community based services
Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
Actively participate in integrated team care management rounds
Identify related risk management quality concerns and report these scenarios to the appropriate resources.
Requirements:
RN license in FL
2+ years clinical
1+ year of discharge planning (hospital) or case management in a clinical or health plan setting.  Must have basic computer skills.
 
    
 
Job ID:FL-CT-3932
Job Title:
Director, Provider Payment Innovations
Rate:
Primary Skills:
Description:
 
    
 
Job ID:FL-CT-3958
Job Title:
Supervisor, UM
Rate:
Primary Skills:
Description:
Supervisor, UM  - ORLANDO
Growing national MCO is adding to the leadership team in Orlando.
  Supervise the daily operations of the utilization management (UM) staff.
Ensure appropriate usage of resources in order to facilitate the UM process.
Ensure compliance within applicable state program guidelines

Evaluate compliance policies and procedures and analyze/recommend enhancements

Assist with ensuring consistent data collection from UM staff that is used to assist the company in achieving corporate goals, to improve monitoring and reporting in order to meet external requirements

Identify opportunities for process improvements necessary to facilitate department functions

Educate staff as necessary to ensure consistent performance and adhere to standards

Assist UM Manager and Director with coordinating and facilitating system processes with providers, partners, vendors, and subcontractors as necessary

Qualifications:
-3+ years of utilization management/quality improvement experience.
-Working knowledge and understanding of basic utilization management and quality improvement concepts.
-Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.
-FL LPN, LVN, or RN license.
 
    
 
Job ID:FL-CT-3975
Job Title:
Behavioral Health Medical Director
Rate:
Primary Skills:
Description:
 
    
 
Job ID:FL-CT-3982
Job Title:
VP, Medical Management
Rate:
Primary Skills:
Description:
VP Medical Management | Health Services -  Ft Lauderdale, FL
VP will be a part of strong & collaborative leadership team with daily interaction with C - Suite executives.
     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 for the Florida 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. Experience with a large staff and a large numbers of lives/members.
-Current  nursing license REQUIRED.
 
    
 
Job ID:FL-CT-3988
Job Title:
Director, Quality
Rate:
Primary Skills:
Description:
 
    
 
Job ID:GA-CT-3460
Job Title:
Manager, Case Mgmt
Rate:
Primary Skills:
Description:
MANAGER, CASE MANAGEMENT

You will love being mentored by the fantastic leadership of this medical management team! National healthcare enterprise is committed to improving the health of the medically underserved with a focus on whole health.

INCREDIBLE growth potential- GENEROUS BENEFITS & RELOCATION!

Lead and develop the case management team in enhancing outcomes for the members they serve.

-Review analyzes of activities, costs, operations and forecast data

-Promote compliance with federal and state regulations and contractual agreements.

-Develop, implement, and maintain case management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure.

-Facilitate on-going communication between case management staff, members, contracted providers, and subsidiaries.

-Develop staff skills and competencies through training and experience.

Qualifications

- Bachelor’s degree in Nursing or equivalent experience.

-3+ years case management experience and recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, or obstetrics.

- Thorough knowledge of case and/or utilization management and clinical nursing.

-Familiarity with Medicaid managed care practices and policies, CHIP, and SCHIP.

-Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

-License/Certification: Unrestricted RN license in applicable state(s) and valid driver's license and automobile insurance. Case Management Certification (CCM) is a plus
 
    
 
Job ID:GA-CT-3883
Job Title:
Director, Case Management
Rate:
Primary Skills:
Description:
 


 


 


Director,
Case Management – Atlanta


______________________________________________________________________________
                 Rich benefit package and generous relocation
Join an innovative leader in the health insurance industry as they continue to excel in managing care for their members in GA.
Director is responsible for defining and directing a complete Case
Management Program in conjunction with corporate goals and objectives




· 
Direct the overall operational leadership of case management functions
and staff




· 
Perform and oversee needs analysis and planning




· 
Work with executive leadership to ensure targets are met for the annual
operating plan/financial management




· 
Ensure compliance with Corporate, State and NCQA standards




· 
Develop and implement methods, policies and procedures to improve the
departments efficiency and effectiveness


 


Qualifications:




- Bachelor's degree in Nursing or related field.


-5+ years of work experience in
managed care and acute care settings with complex case management.


 


-Previous management experience
including responsibilities for hiring, training, assigning work and managing
performance of staff. 


 


- Case management and UM experience
- complex case management


 


- Familiarity with HEDIS and STARS
measures- quality components- QRS






- License/Certification: RN license.


 


 


Preferred:


 


Medicare background.


 


CCM - Case Management Certification


 






 


 


 


 


 
 
    
 
Job ID:GA-CT-3927
Job Title:
Manager, Medical Management (Medicare) RN
Rate:
Primary Skills:
Description:
 
    
 
Job ID:GA-CT-3972
Job Title:
Behavioral Medical Director
Rate:
Primary Skills:
Description: