CLINICAL CARE SERVICES AUDIT & COMPLIANCE MANAGER

Location
Virginia Beach, VA
Posted
Sep 19, 2017
Closes
Oct 28, 2017
Industry
Healthcare
Hours
Full Time
Job Description:
Optima Health is seeking an experienced RN leader to serve in the role as the Clinical Care Services and Compliance Manager position in Virginia Beach, VA.

Assumes responsibility, accountability, and leadership for auditing and compliance of operations within Clinical Care Services. Provides leadership and direct review of coordination of benefits, NCQA/regulatory procedures and customer service within Clinical Care Services. Accountable for coordination of clinical and financial goals, integration of operations into appropriate CCS service areas, review and validation of reports, implementation and maintenance of clinical contracted services. Works independently with direction from the Director of Operations for Clinical Care Services.

Education Level
Bachelor's Level Degree OR
Bachelor's Level Degree - NURSING

Experience
Required: Clinical Management - 5 years, Leadership - 5 years, Managed Care - 5 years

Preferred: None, unless noted in the “Other” section below

License
Required: Registered Nurse

Preferred: None, unless noted in the “Other” section below

Skills
Required: Complex Problem Solving

Preferred: None, unless noted in the “Other” section below

Other
Regulations and Contracts experience required.