RN Director, Medical Management
Job Title: RN Director, Medical Management
Job Description
As an RN Director of Medical Management, you will be responsible for developing, implementing, and updating medical management programs in areas such as utilization management, case management, quality improvement, credentialing, and member/provider appeals to stay updated with healthcare trends and legislative requirements.
You will directly manage the department’s operations for quality management, including credentialing, member and provider appeals, and utilization management. This role involves maintaining delegated status for utilization management and credentialing with all contracted health plans, assisting in the negotiation of health plan delegation agreements, and developing and revising departmental policies to ensure compliance with current legislation and regulations.
Additionally, you will ensure fair and consistent staff recruitment, selection processes, and performance evaluations, support the vision of the whole team, and work collaboratively to provide high-quality services.
Hard Skills Required
This is a contract position with a duration of 6 Month(s).
Work Site
Monday – Thursday, 6:30 AM – 5:00 PM PST (4/10 schedule)
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
Job Description
As an RN Director of Medical Management, you will be responsible for developing, implementing, and updating medical management programs in areas such as utilization management, case management, quality improvement, credentialing, and member/provider appeals to stay updated with healthcare trends and legislative requirements.
You will directly manage the department’s operations for quality management, including credentialing, member and provider appeals, and utilization management. This role involves maintaining delegated status for utilization management and credentialing with all contracted health plans, assisting in the negotiation of health plan delegation agreements, and developing and revising departmental policies to ensure compliance with current legislation and regulations.
Additionally, you will ensure fair and consistent staff recruitment, selection processes, and performance evaluations, support the vision of the whole team, and work collaboratively to provide high-quality services.
Hard Skills Required
- Development and implementation of medical management programs
- Maintenance of utilization management and credentialing
- Negotiation of health plan delegation agreements
- Development and revision of departmental policies
- MSO experience (strongly preferred)
- Recent nursing/outpatient experience
- Previously worked in multiple different units inside an acute setting
- CMS experience is a plus
- Leadership
- Strategic thinking
- Collaboration
- Consistency in staff management
This is a contract position with a duration of 6 Month(s).
Work Site
- This is a hybrid position requiring some days on-site in San Diego, California. On-office required every Wednesday and on Mondays once or twice a month.
- Onsite training for the first 120 days
- Reports directly to the CEO and as Director, this individual also leads meetings with senior level team weekly.
Monday – Thursday, 6:30 AM – 5:00 PM PST (4/10 schedule)
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
- Hiring diverse talent
- Maintaining an inclusive environment through persistent self-reflection
- Building a culture of care, engagement, and recognition with clear outcomes
- Ensuring growth opportunities for our people
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
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Seniority level
Director -
Employment type
Contract -
Job function
Health Care Provider -
Industries
Business Consulting and Services
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