RN Medical Management Leader – Quality & Compliance

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

Benefits offered by this job

Health benefits

401k

Weekly pay

Potential for permanent hire

Job summary

LeoForce is seeking a Medical Management Services Manager (RN) to oversee medical management operations, quality initiatives, regulatory compliance, and departmental performance within a managed care environment.

The ideal candidate is an RN with leadership experience, strong analytical and communication skills, and the ability to drive process improvements while coordinating with internal teams and external partners in Fresno, CA.

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.

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

RN license

Leadership experience

Analytical skills

Communication skills

Microsoft Office

Multitasking

Education

Bachelor's degree in nursing

Master's degree (preferred)

Tools

Microsoft Office

Job description

LeoForce is seeking a Medical Management Services Manager (RN) to oversee medical management operations, quality initiatives, regulatory compliance, and departmental performance within a managed care environment.

The ideal candidate is an RN with leadership experience, strong analytical and communication skills, and the ability to drive process improvements while coordinating with internal teams and external partners in Fresno, CA.