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Vice President, Medical Management (RN)
Ref No.: 17-01764
Category: Permanent Placement
Location: Garden City, New York
Large and rapidly growing managed care organization located in Long Island is currently looking for an experienced Vice President of Medical Management to join their very dynamic team.
JOB SUMMARY
VICE PRESIDENT, MEDICAL MANAGEMENT- REGISTERED NURSE (POSITION LOCATED IN LONG ISLAND)
The Vice President of Medical Management oversees, manages and implements the Utilization Management (UM) functions and ensures compliance with regulatory, industry standards and payor requirements.
ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES OF VICE PRESIDENT, MEDICAL MANAGEMENT:
  • Ensures department and network compliance with regulatory and accreditation agency delegation oversight standards.
  • Reviews UM reports from groups with appropriate personnel and provides an analysis of the findings.
  • Reviews the Corrective Action Plans as necessary, assesses the overall strategies to determine types of programs, monitoring tools and outcomes.
  • Interfaces with groups on a regular basis regarding new issues or regulations
  • Reviews reports from Health plans or other sources regarding groups' performance; identifies deficiencies; reviews their corrective action plans; conducts follow up; provides education as necessary in conjunction with the appropriate staff; and, provides follow up to the appropriate committees.
  • Collates and analyzes UM reports for presentation at appropriate committees.
  • Prepares educational presentations for the groups and committees ‐ UM, Care Management and Health Education.
  • Reviews and updates UM Policies and Procedures Manual and creates new policies, with UM Medical Director, and VP of UM, as needed.
  • Develops the initial and ongoing group UM Work plans and provides a written evaluation of the quarterly, semi-annual and annual work plans.
  • Annually reviews the UM Program, Health Education Program and Population Assessment Programs to ensure they are compliant with all the new regulatory requirements.
  • Participates on state and national level committees to represent and facilitate quality health care throughout the group.
  • Motivates, educates and provides assistance to appropriate staff, committees and network.
  • Other duties as assigned.
QUALIFICATION REQUIREMENTS FOR VICE PRESIDENT, MEDICAL MANAGEMENT
Skills, Knowledge, Abilities:
  • Master level education health care or related field preferred.
  • NYS RN license required
  • Five to seven years of UM experience.
  • Managed care experience
  • Excellent communication skills.
  • Knowledge of accreditation and regulatory agency requirements.

HOW TO APPLY:
Interested in this position? We're interested in you! Please apply by clicking either "Apply " at the top of the page. If there is a problem with the link, please email your resumes along with the job title to careers@rcmt.com today!