Nurse Director of Managed Care

Healthcare system looking to bring on Nurse Director Managed Care! Sign On Bonus and Full Relocation!

• Provides strategic and operational leadership for the health plan's enterprise case management function across two health plans under a centralized clinical operations model.
• Responsible for the operational functions the Case Management team including the direct supervision coaching and counseling of staff.
• Designs standardizes implements and optimizes care management programs to improve quality outcomes enhance enrollee experiences reduce avoidable utilization and ensure regulatory compliance.
• Monitors staff and program performance compares results against goals recommends improvements and decisions aligning with expected outcomes.
• Supports Managers managing case management coordination and care management staff.
• Ensures adherence of case management programs across markets while addressing unique state-specific regulatory and population needs partners closely with Utilization Management Pharmacy Quality Population Health Equity and Provider Relations to drive enterprise clinical performance.

Qualifications:

• Bachelor's degree Nursing
• Master's degree Nursing (MSN) Public Health (MPH) Healthcare Administration (MHA) Business Administration (MBA) or related field preferred
• 8-10 years Progressive experience in managed care or health plan operations required
• 5-7 years Leadership experience in case management care coordination or population health management required
• Demonstrated experience overseeing complex case management programs in Medicaid managed care strongly preferred
• Experience leading multi-market or centralized teams preferred required and
• Experience with regulatory audits (state Medicaid agencies CMS) and NCQA accreditation processes. required and
• CCM - Certified Case Manager Certified Case Manager (CCM) or other nationally recognized case management certification Upon Hire required