Vice President, Medical Management
Company: Centene Corporation
Posted on: October 23, 2019
Position Purpose: Perform duties to direct and coordinate the
medical management, quality improvement and credentialing functions
for the assigned health plan based on, and in support of the
company's strategic plan; establishing the strategic vision and
attendant policies and procedures.
- 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
- Review analyses of activities, costs, operations and forecast
data to determine department progress toward stated goals and
- Serve as a member of management committees on special
- 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.Education/Experience: 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 performance of staff.
License/Certification: Current state nursing license.
Experience with Medicare Advantage preferred.
Centene is an equal opportunity employer that is committed to
diversity, and values the ways in which we are different. All
qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, sexual orientation,
gender identity, national origin, disability, veteran status, or
other characteristic protected by applicable law.
Keywords: Centene Corporation, Chicago , Vice President, Medical Management, Executive , Posen, Illinois
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