Medical Management Services Manager (RN)

RN Leadership Opportunity | Managed Care, Quality & Medical Management

This Jobot Consulting Job is hosted by: Jennifer Whitworth
Are you a fit? Easy Apply now by clicking the "Quick Apply" button and sending us your resume.
Salary: $95,000 - $150,000 per year

A bit about us:

A respected managed care organization dedicated to improving healthcare outcomes through quality-driven programs, member-focused services, and collaborative partnerships across Central California. Committed to regulatory excellence and advancing the health of the communities it serves.

Job Title: Medical Management Services Manager (RN)
Compensation: $95k - $150k/year, depending on experience
Location: Fresno, CA
Schedule: Monday-Friday, 8:00 AM - 5:00 PM
Type: Contract with strong potential for permanent hire

Why join us?

• Competitive hourly compensation paid weekly
• Health benefits and 401k offered during the contract period
• Strong potential for permanent hire
• Monday-Friday schedule (no weekends)
• Collaborative and supportive team environment
• Leadership opportunity within a growing managed care organization
• Opportunity to oversee quality, compliance, and medical management initiatives
• Meaningful work supporting healthcare services throughout the Central Valley
• Opportunity to drive process improvements and organizational success

Job Details

We are seeking a Medical Management Services Manager to oversee medical management operations, quality improvement initiatives, regulatory compliance activities, and departmental performance within a managed care environment. The ideal candidate is an RN with leadership experience, strong operational and analytical skills, and a collaborative management style.

Responsibilities:

• Provide leadership and oversight of Medical Management operations.
• Supervise and support clinical and non-clinical staff.
• Monitor department performance and identify opportunities for process improvement.
• Ensure compliance with regulatory, contractual, and accreditation requirements.
• Support quality improvement initiatives and corrective action plans.
• Oversee reporting, audits, and operational readiness activities.
• Collaborate with internal departments and external healthcare partners.
• Assist with policy development, implementation, and staff education.
• Support Utilization Management, Appeals & Grievances, Quality Improvement, and related programs.
• Track department goals, metrics, and performance outcomes.

Qualifications:

• Active California RN license required.
• Bachelor's degree required; Master's degree preferred.
• Minimum 5 years of progressive healthcare experience.
• Previous leadership, supervisory, or management experience preferred.
• Experience in Managed Care, Medical Management, Utilization Management, Quality Improvement, Healthcare Compliance, Regulatory Audits, HEDIS, NCQA, or related healthcare operations strongly preferred.
• Strong analytical, organizational, and problem-solving skills.
• Excellent communication and leadership abilities.
• Proficiency with Microsoft Office applications.
• Ability to manage multiple priorities in a fast-paced healthcare environment.

Interested in learning more? Apply today or confidentially send your resume to Jennifer Whitworth at https://jobot.com/apply/medical-management-services-manager-rn/1036164932?utm_source=Monster for consideration.

Interested in hearing more? Easy Apply now by clicking the "Quick Apply" button.

<sub>Jobot is an Equal Opportunity Employer. We provide an inclusive work environment that celebrates diversity and all qualified candidates receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Jobot also prohibits harassment of applicants or employees based on any of these protected categories. It is Jobot’s policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions.

Sometimes Jobot is required to perform background checks with your authorization. Jobot will consider qualified candidates with criminal histories in a manner consistent with any applicable federal, state, or local law regarding criminal backgrounds, including but not limited to the Los Angeles Fair Chance Initiative for Hiring and the San Francisco Fair Chance Ordinance.

Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal.

By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Jobot, and/or its agents and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here: jobot.com/privacy-policy</sub>