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Job description
Medical Management Services Manager (RN)
Job Description
Experience: Manager
Salary: $95,000 - $150,000 per year
Job Details
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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.
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.
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.
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
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Worksite address
fresno, CA, 93650, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.