Manager, Medical Management (Medicare) RN

Location: Atlanta, GA
Position Purpose: Responsible for managing a complete Medicare Advantage program of medical management in accordance with the mission, philosophy, and objectives of plan. The position has oversight for the functions of utilization management and case management.
 
  • Implement changes to medical service functions and performance in relation to Medicare guidelines, company mission, philosophy objectives and policies
  • Manage budgets and forecast for strategic planning and key initiatives and balance current future needs effectively 
  • Research and incorporate best practices into operations
  • Assure compliance of work processes with Medicare Advantage and CMS regulations
  • Responsible for the statistical analysis of utilization data
  • Participates in NCQA accreditation of the Plan.

Qualifications:
Education/Experience:
  • Bachelor's degree in Nursing or equivalent experience.
  • 3+ years combined nursing, quality improvement and managed care experience.
  • Proficiency in Microsoft Applications, preferably excel.
  • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
  • Previous experience managing Medicare Advantage programs preferred. 
  • Medicare experience highly preferred
 
‚ÄčLicense/Certification: RN license.
April A. Estes
Senior Recruiter
720-439-2609 Direct
april@proenlist.com 
www.proenlist.com 

Follow us at:
www.linkedin.com/in/aprilaestes
www.linkedin.com/company/proenlist/

 
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