Vice President Medical Management permanent position at Troy MI
Company: MIT RESOURCE
Location: Troy
Posted on: November 1, 2024
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Job Description:
Vice President Medical Management permanent position at Troy
MI
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.
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Keywords: MIT RESOURCE, Saint Clair Shores , Vice President Medical Management permanent position at Troy MI, Executive , Troy, Michigan
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