Vice President Medical Management position at Troy MI

• Full-time

Title: Vice President Medical Management

Location: Troy, MI

Type: Permanent

Job Description:

Position

Purpose:

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.

• 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.

Required Qualifications:

• 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.

• 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 with 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.