RN Leader (Medical Management)

Morgan Consulting Resources, Inc. - Healthcare Executive Search; Modesto (CA); On-site; USD 150,000 - 190,000; Full time

Job summary

AllCare IPA in Modesto, CA is seeking a Clinical Operations Leader (RN) to guide a team of about 24 nurses and clinical staff. The role focuses on strategic oversight, operational performance, and regulatory integrity within a capitated managed care framework.

The ideal candidate will bring a California RN license, 5–7 years of clinical management experience in delegated IPA/health plan settings, and strong knowledge of CMS/DHCS requirements to drive quality and efficiency.

Qualifications

• Current, unrestricted RN license and eligibility to obtain California RN licensure.
• 5-7 years of clinical and healthcare management experience including in the acute hospital setting.
• Minimum of 5-7 years of clinical management experience in California delegated capitated IPA, medical group, health plan, or managed care organization.
• Strong knowledge of California managed care regulations in a risk-based environment.
• Experience interacting with CMS, DHCS, NCQA, and health plan delegation.

Responsibilities

• Oversee a team of approximately 24 nurses and clinical support staff.
• Provide strategic oversight, operational performance, and regulatory integrity of medical management within a capitated managed care environment.

Skills

Nursing leadership

Healthcare management

Regulatory knowledge

CMS/DHCS familiarity

HEDIS/STARS knowledge

Education

RN license

Job description

Morgan Consulting Resources, Inc. has been retained to conduct the search for a Clinical Operations Leader (RN). This is an outstanding opportunity to be an integral member of a dynamic organization, AllCare IPA based in Modesto, CA. This position will be based onsite in Modesto.

About the Organization:

Established in 1989, AllCare Independent Physician Association (IPA) is a strategic, forward-thinking physician organization committed to delivering high-quality care while driving operational excellence, financial performance, and sustainable growth. With more than 1,259 contracted physicians, AllCare IPA has earned a strong reputation as an innovative and respected organization serving physicians and patients throughout San Joaquin, Stanislaus, and Merced counties.

At the heart of AllCare IPA’s success is a culture built on collaboration, stability, and long-term relationships. Their 316 employees are part of a team where their ideas and contributions are valued, bureaucracy is kept to a minimum, and individuals are empowered to make a meaningful impact. They take pride in fostering an environment where employees can build rewarding careers while enjoying excellent benefits, supportive leadership, and a strong sense of purpose.

For more information see: https://www.allcareipa.com

About the Position:

Reporting to the CEO, the Clinical Operations Leader (RN) oversees a team of approximately 24 nurses and clinical support staff and is responsible for the strategic oversight, operational performance, and regulatory integrity of the organization’s medical management functions within a delegated, capitated managed care environment.

This role will be a good fit for RN leaders with:

• Health plan or provider/medical group experience;
• CA managed care background;
• Knowledge of delegated models;
• Knowledge of CMS and DHCS regulatory expectations; and
• Knowledge of UM, CM, HEDIS/STARS performance initiatives and physician engagement strategies.

Education and Experience:

• Current, unrestricted RN license and eligibility to obtain California RN licensure if not already licensed in the state.
• 5-7 years of clinical and healthcare management experience including in the acute hospital setting.
• Minimum of 5-7 years of clinical management experience in California delegated capitated IPA, medical group, health plan, or managed care organization, including management of nursing and operations staff.
• Strong knowledge of California managed care regulations in a risk-based environment.
• Experience interacting with CMS, DHCS, NCQA, and health plan delegation.