Position Purpose: 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.

• 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:

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.License/Certification: Current state nursing license.

Employee Status:

Regular

Job Level:

Corporate VP/Field CEO

Job Type:

Regular

More Information About the Job

Is Relocation Available?Yes, nationwideIs there a bonus structure?20% or higherAre you open to sponsorship?NoThis position is:BackfillIs there a possibility to work remote?NoIs there equity?NoAre there flexible work hours?YesDoes this position have direct reports?YesWho does this position report to?Plan PresidentWhat are the 3-4 non-negotiable requirements on this position?Must be an RN with a Bachelor's Degree and 10 years experience as an RN. Must have significant managed care experience, preferably in Medicaid. Must have or be able to obtain an unrestricted Illinois nursing license. 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.What are the nice-to-have skills?Master's decree preferred Project management Experience Previous experience rebuilding/building highly functioning teamsWhat is exciting about this opportunity? Please use this section to describe team and company culture.It is an excellent opportunity for the right candidate, with collaborative interpersonal skills to play a critical role in defining what is, the largest part of the health plan, and develop the department to achieve success. Selected candidate will be a valued member of the senior leadership team.Contact me for details: Gary@GaryLouisNelson.comMore opportunities.