Associate Director, Health Services Nursing

Responsibilities

• Drive excellence in care management and utilization management clinical operations
• Collaborate with clinical and operational teams to support growth and optimize performance
• Supervise care management and utilization management teams to ensure high-quality service delivery
• Monitor performance metrics to evaluate the effectiveness of care management activities
• Oversee compliance with state and national healthcare standards
• Develop and execute departmental policies responsive to contract changes
• Facilitate collaboration across departments to enhance member outcomes

Qualifications

• Active, unrestricted RN license in South Carolina with no disciplinary actions
• Bachelor's degree in nursing or related healthcare field
• 3+ years of clinical leadership experience in utilization management
• 3+ years of care management leadership experience
• 3+ years of Medicaid-related experience
• Familiarity with InterQual, MCG, and/or ASAM criteria
• Comprehensive knowledge of Microsoft Office applications
• Understanding of Medicaid regulations and NCQA standards

Pay

$104,000 – $143,000 annually

Schedule

Remote - US based candidates only, no visa sponsorship available