The Carolinas Center for Medical Excellence (CCME) is a non-profit health care quality consultancy and QIO-like Entity certified by Centers for Medicare and Medicaid Services (CMS) founded by physicians in 1983. Headquartered in North Carolina’s Research Triangle, we offer an array of quality improvement, clinical review, audit, technical, and consulting services and solutions to improve care delivery, system performance, and patient outcomes.
What You’ll Do
We are seeking an (RN) Director of State Review Services with exceptional leadership and interpersonal skills to oversee the operations of health-care related contracts(primarily Medicaid) and business development activities within the department. The candidate must be a strategic thinker with experience eliciting high-level business requirements and the ability to develop creative and breakthrough solutions for current and future customers. To ensure success, the Director of State Review Services should be accustomed to working in a fast-paced environment with an operational mindset, attention to detail, and a focus on identifying value to challenging business problems.
We expect you to:
Provide functional support, leadership, education and strategic direction for contract managers, and clinical and administrative staff
Ensure consistency and conformance to all contract applicable standards and requirements
Ensure operational processes are meeting contractual timelines and desired outcomes
Initiate organizational and system changes to continually improve departmental staffing efficiency
Assume responsibility and accountability for operations and success of assigned areas
Work with the business proposal development team as a service line leader in responding to public and private sector requests for proposals (RFPs) and grants, ensuring the timeliness, accuracy, and quality of related documents
Who You Are
The successful candidate will possess a strong business acumen, demonstrated track record of continuing responsibilities, creativity and innovation, and a desire to deliver a high standard of service to internal and external customers.
Our requirements for this role:
Bachelor’s Degree in Nursing, Healthcare Administration, or health-related field; Master’s degree preferred
Active RN license required
Minimum of five (5) years of experience in managing utilization and quality review services, preferably to public sector clients such as Medicaid State Agencies
Experience in the practical application of quality improvement methodologies to operational processes and systems
Knowledge of Medicaid policies related to clinical and quality review
We offer a competitive salary and benefits package and a flexible work environment.
Equal opportunity employer of protected veterans
Equal opportunity employer of individuals with disabilities
We do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, gender identity, national origin, medical condition, disability, veteran status, or any other basis protected by law.
Applicants and employees are protected from discrimination based on inquiring about, disclosing, or discussing compensation or the compensation of other applicants or employees.
CCME is a nonprofit recognized as a leader in improving health care quality.
Founded by physicians as a 501(c)(3) nonprofit organization in North Carolina in 1983, The Carolinas Center for Medical Excellence (CCME) is recognized as a leader in improving health care quality, by providing innovative services and solutions to create healthier communities.
CCME achieves this by implementing best-practices and proven solutions to improve population health, reviewing the financial integrity of health systems, and ensuring private practices and networks of providers have access to the latest technology and data-driven analytics.
With over 30 years of quality improvement experience, CCME also provides innovative, cost-effective clinical review and consulting services. We assist state Medicaid departments, hospitals, accountable care organizations, and providers of all types manage their data and claims to benefit patients, providers, and payers, simultaneously.
Since 1984, CCME has performed utilization review and quality improvement activities as a CMS-designated Quality Improvement Organization (QIO)—and with the evolution of the system into Quality Innovation Networks—as ...a Quality Innovation Network-Quality Improvement Organization (QIN-QIO).
CCME is a member of the Atlantic Quality Innovation Network (AQIN), the QIN-QIO for New York, South Carolina, and the District of Columbia, and serves as the QIO for South Carolina.