JobTitle: Registered Nurse Medical Management Manager – Direct Placement

　　Overview:

　　We are seeking adynamic and experienced Medical Management Manager to lead our office, service,and quality improvement programs for the Medi-Cal Managed Care business. As akey member of our team, you will ensure compliance with accreditation, state,and federal requirements, acting as a crucial backup to the Director of MedicalManagement.

　　PaySalary: $85,000 - $100,000

　　Responsibilities:

　　Oversee and managethe review and revision of Medical Management policies and procedures to ensurecompliance with current statutes and regulations.

　　Directly manage theMedical Management staff, providing leadership and guidance in departmentalactivities.

　　Coordinate thepreparation and submission of documents and policies for DHCS/DMHC MedicalAudits.

　　Lead delegationoversight audits of the Plan Administrator, developing reports and analyzingaudit findings.

　　Coordinate Appealsand Grievances Work Group preparation, including drafting agendas, gatheringreports, and follow-up actions.

　　Prepare and reviewrequired reports, program documents, and work plans as requested.

　　Support andparticipate in Quality Improvement projects and teams, contributing to meetingagendas, tracking logs, and regulatory submissions.

　　Attend variouscommittee meetings, including Quality Improvement/Utilization ManagementCommittee, QI Work Group, Monthly Case Management, Utilization Management,HEDIS, and other routine and ad hoc meetings.

　　Function as a backupfor the Appeal & Grievance file transfer process, ensuring completeness forregulatory audits.

　　Other duties asassigned by the Director.

　　MinimumQualifications:

　　Healthcare-relatedBachelor’s degree or completion of an accredited RN program required.

　　Master’s degree (MPHor MPA) highly desirable.

　　Certification inHealthcare Quality (CPHQ) desirable.

　　RN license asappropriate.

　　Current driver’slicense.

　　Five yearsprogressive experience in Healthcare Quality Improvement and/or ProjectManagement.

　　Previous managerialexperience preferred.

　　Minimum of two years’experience in a healthcare service environment.

　　Knowledge,Skills & Abilities:

　　Strong knowledge ofhealthcare federal, state, and NCQA standards and regulations.

　　Proficient inMicrosoft Office: Word, Excel, PowerPoint, Access, and Outlook.

　　Excellentorganizational, analytical, and problem-solving skills.

　　Ability to develop,analyze, interpret, and communicate healthcare data reports and processeseffectively.

　　Strong verbal andwritten communication skills.

　　Proactive,independent, and able to prioritize projects.

　　Team player fosteringeffective working relationships at all organization levels.

　　Demonstratesmaturity, integrity, loyalty, initiative, creativity, and sound judgment.

　　PhysicalRequirements:

　　Constant and closevisual work at a desk or computer.

　　Extensive typing.

　　Frequent verbal andwritten communication with staff and business associates.

　　Frequent walking andstanding.

　　Frequent lifting offolders, files, binders, and other objects weighing between 0 and 30 lbs.

　　Reliabletransportation required; occasional travel between Kings, Madera, and Fresnocounties and offices for meetings.

　　If you are a qualifiedcandidate ready to contribute to a dynamic healthcare environment, we inviteyou to apply for this exciting opportunity. Join us in making a positive impacton the healthcare experience for our community.

　　Please call559-490-5605 and ask for Arin

　　Benefits

　　At Maxim Healthcare Staffing, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:

　　Competitive pay & weekly paychecks

　　Health, dental, vision, and life insurance

　　401(k) savings plan

　　Awards and recognition programs

　　*Benefit eligibility is dependent on employment status.

　　About Maxim Healthcare Staffing

　　Maxim Healthcare Staffing has been making a difference in the lives of our patients, caregivers, and employees for more than 30 years. Our nationwide suite of services includes home healthcare, companion and behavioral care, healthcare staffing, and workforce solutions. Maxim's commitment to customer service, compassionate patient care, and filling critical staffing needs makes us a trusted partner wherever healthcare is needed.

　　Maxim Healthcare Staffing is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.