RN Program Manager, Medicare Advantage Program
Job Opportunity at PROFLUENCE RECRUITMENT

Posted on Nov 7

415-547-9089

Location: Columbia, SC
Job Type: Full Time
Job ID: W4145974

LOCATION: Columbia, SC
 
FACILITY DESCRIPTION:  Large statewide managed care plan
 
REPORTS TO: Executive Director Clinical Consulting
 
POSITION DESCRIPTION: (Note: go live for program 01/01/2018)
 
  • Develop and manage various health management programs including Case, Utilization and Disease Management as well as Behavioral Health and Healthcare Development with 3 nurses (eventually up to 25) – expect 6000 to 10,000 members.
  • Lead 3 nurses (eventually up to 25) – expect 6000 to 10,000 members.
One RN covers UM & is a Discharge Planner from hospital side 
one RN worked on the program in 2014,
one RN covers FEP (Federal Employee Program)
  • Assess impact of programs, perform cost-benefit/feasibility analyses.
  • Perform market research assessing corporate competitiveness.
  • Provides strategic direction for reporting including design, analysis and validation of outcomes and ROI.
 
REQUIRED EDUCATION/EXPERIENCE:
 
  • RN, BSN preferred. Must have Medicare Advantage experience!!
  • 5+ years clinical experience. Strong leader!
  • 2 to 5 years supervisory role or equivalent military experience grade E4 or above
  • Experience developing, implementing and evaluating population health programs
  • Ability to understand and communicate healthcare policy
Active unrestricted RN license or NLC, unrestricted multi-state Compact license

Excellent bonus + interview and relocation program.  Merit review Mar. through May depending on start date.
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