Associate VP of Medical Management (RN)

Location: Jackson, MS
Date Posted: 11-01-2018
Associate Vice President of Medical Management (RN) - Health Plan
Jackson, MS
$$$ Generous Relocation Package available to attract top-talent from around the Nation! $$$

VP of Medical Management Job Summary: 
  • Provides strategic direction and oversight for one or more of the following key Healthcare Services functions: case management/disease management/care transitions; utilization management; long-term supports and services; and/or nurse advice line.
  • Determines clinical, quality, and financial measures for success.
  • Designs standardized protocols, develops policy, and ensures timely implementation with corporate and health plan input.
  • Ensures adequate training occurs from knowledgeable staff and coordinates with other departments as needed.  Focuses on continual refinement of operational processes.
  • Develops, performs and promotes interdepartmental integration and collaboration to enhance clinical services.
  • Manages and evaluates team members in the performance of various clinical management activities.
  • Coordinates with the Vice President of Healthcare Services to ensure adequate staffing and service levels, and maintains customer satisfaction by implementing and monitoring staff productivity and performance indicators.
  • Ensures monthly auditing is occurring with appropriate follow-up.
  • Engaged in clinical training activities and outcomes.
  • Develops and mentors HCS managers and supervisors. 
VP of Medical Management  Background Profile: 
  • Requires a valid, unrestricted state Registered Nurse (R.N.) license & Bachelor of Science in Nursing (B.S.N.) or related field; Master’s Degree in Nursing, Healthcare Administration or related field preferred.
  • Certification in Utilization Management (CPUM/CPUR, now CPHM) Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification is highly desired)
  • Requires around 3-6 years’ clinical nursing experience; preferably in an acute care hospital setting.
  • At least 10 years’ experience with medical management (CM/UM/QM) at a Managed Care Organization, such as Health Plan, IPA, Medical Group, or HMO.
  • Requires 5-7 years previous health plan management experience, in roles of increasing responsibility.
  • Significant Medicare and Medicaid managed care experience with direct responsibility for clinical operations  including prior authorization, utilization management operations
  • Experience with strategic planning, implementing, and evaluating clinical programs.
  • Knowledge of utilization management, quality improvement, discharge planning, and cost management.
  • Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
  • Excellent verbal and written communication skills, as well as exceptional critical thinking skills.
  • Possess very strong coaching/counseling skills including the ability to function as a mentor to management and employees.
  • Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.


Division Vice President - I.T.
CareNational Healthcare Services
480.681.0168 (CALL – TEXT – FAX)
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