Apple & Associates, Inc.
175,000 - $180,000
Strong dynamic team part of a Fortune 100 growing enterprise is seeking a high-level nurse leader with a decade of medical management experience.
This highly visible role will involve presenting to key stakeholders, coordinating with the medical management, quality improvement, and credentialing teams to support the strategies, vision, and policies of the health plan organization.
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.
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.
Thorough 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 of National Committee on Quality Assurance (NCQA) accreditation process and standards.
Previous management experience including responsibilities for hiring, training, assigning work and managing the performance of staff.
At Apple & Associates, we understand that relationships are what make us stand apart. Whether you are a client or a candidate, you are an extension of the Apple & Associates’ family. Many of our recruiters have been with the company since its earliest days. They take great pride in the relationships they build; always emphasizing high standards, ethics and quality service. Our President, Debi Apple started her recruiting career in Aiken, South Carolina. She quickly became a top producer and leading authority in recruiting for the medical device, pharmaceutical and consumer product industries. Her passion and drive led her to open Apple & Associates in 1993. Under her leadership, Apple & Associates has grown to be one of the leading recruiting firms in these industries. Our company is proud to represent two of the largest medical device and pharmaceutical companies in the U.S., Covidien (formerly known as Tyco Healthcare) and our first and longtime client, Becton Dickinson. Now headquartered in Chapin, South Carolina, Apple & Associates has offices from coast to coast, offering regional recruiting expertise throughout the U.S. and Latin America. Our searches and permanent placements represent all levels, from CEO to staff level positions.