This job is closed
Applications are no longer available for this announcement. Explore current related opportunities below.
Job description
Overview
Director of Health Services — Miami, FL. Our client is seeking an experienced, Senior Director (or Executive Director) of Health Services to lead their Health Services department. This role requires a proven track record in Medicare Advantage health plans with strong case management expertise. The successful candidate will oversee a team of 25 professionals involved in case management and concurrent review, ensuring efficient operations, optimizing resources, and maintaining high quality member care. This person must be an RN licensed in Florida to be considered.
Key Responsibilities
Lead, plan, and manage the Health Services department to maximize productivity and control costs
Coordinate with providers, members, and internal teams to facilitate optimal care delivery
Oversee case management and utilization review activities
Ensure compliance with Medicare Advantage guidelines and standards
Utilize data analytics to drive performance improvements and operational excellence
Qualifications
Current, valid Florida Registered Nurse (RN) license required
Graduate of an accredited School of Nursing
Minimum 5 years clinical nursing experience
Minimum 8 years of Utilization Management and/or Case Management experience within a health plan environment
Minimum 5 years leadership/management experience (not nurse supervisor roles)
Deep knowledge of utilization review, medical terminology, care levels, treatment modalities, statutes, and healthcare delivery models
Experience working specifically with Medicare Advantage populations
Proven organizational skills, time management, and ability to juggle multiple priorities
Strong data and analytics proficiency
Seniority level
Director
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care, Public Health, and Health and Human Services
#J-18808-Ljbffr
Worksite address
miami, FL, 33222, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.