Showe and Associates LLC
Executive Recruiting Services for the Managed Healthcare Industry

VP, Health Services | Medical Management

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Location
Columbia, SC
Job Type
Direct Hire
Date
Sep 05, 2019
Job ID
2673792

  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 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.