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VP Medical Management | Health Services

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Location
Columbia, SC
Job Type
Direct Hire
Degree
Bachelor
Date
Dec 09, 2018
Job ID
2642230
VP Medical Management | Health Services -  South Carolina
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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 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.