RN Medical Management Leader — Managed Care (On‑Site)

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

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.