Job Description :
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 performance of staff.

License/Certification: Current state nursing license (RN

* RN * CCM (Certified Case Manager)
* Managed a large team at a Senior Level (Sr. Director and above)
* 10+ years of clinical nursing, quality improvement, and management experience in a managed care setting.
* Built a care management model and implemented it.
* Strong interpersonal and communication skills-must have the ability to understand how to change the message per the audience
* Strong analytic skills and data orientation—seeks to understand medical trends and use data when making decisions
             

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