Medical Management Services Manager (RN)

Australia-Employment; Fresno (CA); On-site; USD 95,000 - 150,000; Full time

Benefits offered by this job

Health benefits

401k

Weekly pay

Mon-Fri schedule

No weekends

Leadership opportunity

Job summary

Jobot in Fresno, CA seeks a Medical Management Services Manager (RN) to oversee medical management operations, quality initiatives, and regulatory compliance in a managed care setting.

The ideal candidate is an RN with leadership experience, strong operational and analytical skills, and a collaborative management style. This is a contract role with potential for permanent hire and a Monday–Friday, 8:00 AM–5:00 PM schedule.

Qualifications

• Active California RN license required.
• Bachelor's degree required; Master's degree preferred.
• Minimum 5 years of progressive healthcare experience.
• Leadership or management experience preferred.
• Experience in Managed Care, Medical Management, Utilization Management, Quality Improvement or related healthcare operations 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.

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.

Skills

Leadership

Analytical skills

Communication

Prioritization

Team management

Education

Bachelor's degree

Master's degree

Tools

Microsoft Office

Job description

Medical Management Services Manager (RN)

$95000 - $150000 per year | Fresno, CA | On-site | Consulting

RN Leadership Opportunity | Managed Care, Quality & Medical Management

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.

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.