Associate Director, Health Services Nursing

This is a fully remote position, open to applicants in South Carolina.

📋 Description

• Responsible for ensuring excellence in care management (CM) and inpatient utilization management (UM) clinical operations.

• Oversee the assessment and evaluation of members' needs and requirements to promote and sustain optimal wellness.

• Assist members and their families in connecting with appropriate resources for their care and overall well-being.

• Provide supervision and daily guidance to the care management and utilization management teams.

• Monitor and assess performance metrics and outcomes to guarantee the effectiveness and quality of care management efforts.

• Develop and implement departmental policies and procedures in alignment with contract modifications and updates.

⛳️ Requirements

• A current, unrestricted Registered Nurse (RN) license in the State of South Carolina, free from any disciplinary actions.

• A Bachelor’s degree in nursing (BSN) or a related healthcare discipline.

• At least three (3) years of clinical leadership experience in utilization management.

• A minimum of three (3) years of leadership experience in care management.

• Three (3) or more years of experience related to Medicaid.

• Familiarity with InterQual, MCG, and/or ASAM criteria.

• Strong proficiency in Microsoft Office applications, including PowerPoint, Word, Excel, and Outlook.

• Knowledge of Medicaid regulatory requirements and standards set by the National Committee for Quality Assurance (NCQA).

🏝️ Benefits

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Time off, including paid time off, company and personal holidays, as well as paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Numerous additional opportunities.