Senior Director, Medical Management (RN)

Location: Atlanta, GA
Position Purpose: Direct medical management program including utilization management, case management, and quality improvement in accordance with the mission, philosophy, and objectives of the plan and in conjunction with Corporate goals and objectives.
 
  • 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 d
  • 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.

Qualifications:
Education/Experience: Bachelor's degree in nursing, related field, or equivalent experience. 7+ years of clinical nursing, quality improvement, and management experience in a managed care setting. 

License/Certification: Current state nursing license.
  • Strong leadership/management experience is highly preferred.
  • CCM is desired.
  • Familiarity with Commercial, Medicare and Medicaid is a plus.
  • Program development and knowledge of NCQA and CMS standards is highly desired. 
April A. Estes
Senior Recruiter
720-439-2609 Direct
april@proenlist.com 
www.proenlist.com 
www.medenlist.com 

www.linkedin.com/in/aprilaestes
 
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