Job Openings

VP Health Services | Medical Management - PA

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Harrisburg, PA
Job Type
Direct Hire
Feb 20, 2020
Job ID

VP Health Services | Medical Management - PA


(Harrisburg, Philly, Pittsburgh)

Key health plan leader will have a BIG opportunity to make an impact on quality and accessibility of healthcare. VP will guide and coordinate the medical management, quality improvement and credentialing functions across multiple product lines for growing health plan.

VP will enjoy a talented peer group, innovative culture and strong analytic and technical support. 

                         GENEROUS relocation - unlimited career potential

-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 NCQA and/or 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.




- Bachelor's degree in Nursing, related field

-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 knowledge of QI 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 NCQA accreditation process and standards.

Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

- Current nursing license. (PA within 90 days of hire)