RN Senior Director of Medical Management

Location: Atlanta, GA
Date Posted: 05-01-2018
RN Senior Director of Medical Management - Managed Care
Atlanta, GA
Senior Director of Medical Management Job Summary:
  • Direct medical management program including utilization management, case management, and quality improvement in accordance with the mission, philosophy, and objectives of the plan
  • Develop department objectives and organize activities to achieve objectives
  • Evaluate and implement changes to medical service functions and performance in relation to company mission, philosophy objectives and policies for multiple health plans
  • Participate as a subject matter expert in implementation of new health plans
  • Manage budget and forecast for strategic planning and key initiatives
  • Coordinate with operating departments on research and implementation of best practices
  • Responsible for the statistical analysis of programs related to utilization and case management
  • Participate in NCQA, State, and/or other accreditations of the Plan
  • Organize and present new concepts, programs and tools to staff and health plans
  • Serve as a mentor for multiple plans and staff
  • Develop communication plans with external providers such as hospitals and State agencies as required to facilitate plan goals and objectives
  • Coordinate with Medical Director to educate and communicate expectations with providers
Senior Director of Medical Management Background:
  • Valid, unrestricted state Registered Nurse (R.N.) license, and a Bachelor’s Degree in Nursing (BSN) or related field; Master’s degree is a plus.
  • Certified in Case Management (CCM) is highly desired.
  • Around 3-5 years’ clinical nursing experience in a high acuity setting.
  • Roughly 7-9 years’ experience in Care Coordination/Utilization Review/Quality Improvement for a Managed Care Organization (Health Plan, IPA, HMO, TPA, etc).
  • At least 5-7 years previous management experience, in roles of increasing responsibility, which included hiring and supervising nurses.
  • Familiar with Commercial, Medicare, and Medicaid plans, as well as claims payment rules and their impact on care management processes.
  • Program development and knowledge of NCQA and CMS standards is highly desired.
  • Knowledge of healthcare & insurance industry current and future trends, in order to assess future market needs.
  • Strong computer proficiency (MS Office) and typing skills are necessary.
  • Skilled in influencing, leading and directing individuals in multiple functional areas.
  • Able to transform assignments from high-level objectives into independently established detailed goals.
  • Excellent verbal and written communication skills, as well as exceptional critical thinking skills.
480.269.9491 (CALL – TEXT – FAX)
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