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Vice President, Medical Management

Little Rock, AR · Healthcare
Overview:
Perform duties to direct and coordinate the medical management, quality improvement and credentialing functions for the assigned health plan based on, and in support of the company’s strategic plan; establishing the strategic vision and attendant policies and procedures.  This position will oversee the Medicaid division and be based in the Little Rock, AR office full-time.  Remote/Telecommute is not available.


Responsibilities:
  • 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:
Education/Experience:
  • 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.
  • Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. 

License/Certification: Arkansas RN (Registered Nurse)

 
Kat Forester
ProEnlist, LLC

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