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Manager, Medical Management

Appleton, WI

Manager, Medical Management

Job Description

Manager, Medical Management - Appleton 

Provide leadership for experienced clinical team in growing satellite office (12 direct reports),  Manager will be responsible for managing a complete program of medical management in accordance with the mission, philosophy, and objectives of plan. Oversight includes both UM and CM.

Manager will implement changes to medical service functions and performance in relation to company mission, philosophy objectives and policies, as directed. Manage budgets and forecast for strategic planning and key initiatives. Balance current future needs effectively

Research and incorporate best practices into operations
Assure that Medical Services functions and responsibilities are coordinated with other operating departments of the Plan and Corporate
Responsible for the statistical analysis of utilization data
Participates in NCQA accreditation of the Plan



Job Requirements

Qualifications:

- Bachelor’s degree in Nursing or equivalent experience.

- 3+ years of nursing experience, including quality improvement experience in a healthcare environment, preferably in managed care (possibly acute care experience may be considered – and possibly home health)

-Previous experience as a manager or lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. 

- Understanding of EI and employee engagement

- Experienced in managing to metrics

- Strong technical skills - Excel - Powerpoint

- Able to understand and utilize data.

- License/Certification: RN license.

About MMS Group

MMS is a Managed Care executive search firm. We are Managed Care's complete recruiting resource.

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