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RN DIrector | Case Management, Utilization Review

Raleigh, NC
We're working on behalf of one of the nation's leading health plans -  an organization that serves millions of members in state-sponsored programs across the nation. Each of its health plans is unique to the state it serves.  Their approach centers on a strong local presence, community-based expertise, and relationships coupled with national resources as well as best and promising practices. They draw from the experience of all their affiliate plans and leverage a centralized infrastructure that offers broad knowledge, cost-efficiency, and scale. This creates a perfectly balanced local health plan positioned to meet the needs and preferences of the many specialized member populations they serve.

Looking for an opportunity with a healthcare leader? We seek a Registered Nurse with five (5( or more years of demonstrated care management/population health experience in a large healthcare corporation serving Medicaid beneficiaries for the role of DIRECTOR II HCMS. In this role you will be responsible for the development, implementation, and oversight of integrated Medical Management of more than one member population type with varying degrees of medical complexity. You will oversee case and utilization management execution/decision making for managed member populations. You will be accountable to plan executive or executive team member dependent on plan size/complexity and be involved in the development of the strategic vision, goals, and objectives for medical management. You will serve as liaison to state regulatory agencies.

Candidates should have a Bachelors degree in Nursing and be licensed as an RN in the state of North Carolina (or have the ability to gain this licensure). Preference given to candidates with a Masters degree. Must have at least ten (10) years of clinical work experience that includes prior management experience. Must have five (5) or more years of demonstrated care management/population health experience in a large healthcare corporation serving Medicaid beneficiaries. Must have five (5) or more years of upper management experience (Director or above level). Must have five (5) or more years of managed care experience. Must have experience leading utilization management and case management. Experience leading behavior health preferred. Previous experience with NCQA accreditation and HEDIS reporting preferred.

The role offers highly competitive compensation and benefits.  This is a great opportunity to join a healthcare organization that focuses on improving health and wellness one member at a time, by doing the right thing for every member every time. They engage and support members and their families to be active participants in their care and to help them make healthy, informed decisions. For more information call 941.739.1400 or submit your resume now by clicking on the button below that says "Apply Now."
Eric Boelkins
Edge Recruitment Solutions
888.666.2450 or 941.739.1400
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