At Shire, we are proud and grateful to employ military veterans and thank them for their contributions to our company and our country. See where your military experience can play a role at Shire by using our military skills translator job search tool below:
Job Title: RN Director, Medical Management
Job Description
As an RN Director of Medical Management, you will be responsible for developing, implementing, and updating medical management programs in areas such as utilization management, case management, quality improvement, credentialing, and member/provider appeals to stay updated with healthcare trends and legislative requirements.
You will directly manage the department’s operations for quality management, including credentialing, member and provider appeals, and utilization management. This role involves maintaining delegated status for utilization management and credentialing with all contracted health plans, assisting in the negotiation of health plan delegation agreements, and developing and revising departmental policies to ensure compliance with current legislation and regulations.
Additionally, you will ensure fair and consistent staff recruitment, selection processes, and performance evaluations, support the vision of the whole team, and work collaboratively to provide high-quality services.
Hard Skills Required
Development and implementation of medical management programs
Maintenance of utilization management and credentialing
Negotiation of health plan delegation agreements
Development and revision of departmental policies
Hard Skills (Preference)
MSO experience (strongly preferred)
Recent nursing/outpatient experience
Previously worked in multiple different units inside an acute setting
CMS experience is a plus
Soft Skills
Leadership
Strategic thinking
Collaboration
Consistency in staff management
Job Type
This is a contract position with a duration of 6 Month(s).
Work Site
This is a hybrid position requiring some days on-site in San Diego, California. On-office required every Wednesday and on Mondays once or twice a month.
Onsite training for the first 120 days
Reports directly to the CEO and as Director, this individual also leads meetings with senior level team weekly.
Work Environment
Monday – Thursday, 6:30 AM – 5:00 PM PST (4/10 schedule)
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
Hiring diverse talent
Maintaining an inclusive environment through persistent self-reflection
Building a culture of care, engagement, and recognition with clear outcomes
Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.