Clinical Quality Program Manager - Registered Nurse (RN)

Job ID: KB-1020235 Description:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can email us here to request reasonable accommodations.

Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "my account" and click on "View your job submissions".

This position can be work-from-home after orientation and with management approval but the preference is for this position to be based out of San Antonio, TX or Richardson, TX.

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BASIC FUNCTION:

This position is responsible for developing, coordinating, leading, integrating, and monitoring projects; establishing best practices; analyzing patters of utilization through reporting; and representing the company and department before internal or external customers. Manage the client auditing program, conduct clinical research, and develop and sustain working relationships with client representatives and internal department staff.

JOB REQUIREMENTS:

  • Registered Nurse (RN) with unrestricted, current license in the state of operations.
  • 3 years of clinical experience.
  • Knowledge of medical terminology and procedures.
  • 3 years of experience in utilization management and case management in a managed care environment.
  • Experience in Managed Care Programs and process/procedure development or process improvement.
  • Project management experience and skills to include project leadership, development and implementation.
  • Analytical skills and experience in conducting clinical research.
  • Knowledge of federal and accreditation standards and regulations for the health insurance industry (URAC, NCQA, TDI and/or comparable regulatory bodies).
  • PC skills and familiarity with various software packages including spreadsheets and presentations.
  • Verbal and written communication skills to include presentation skills and representing the company to client representatives.

PREFERRED JOB REQUIREMENTS:

  • Experience with motivational interviewing, member experience improvement projects, clinical program audits and/or CPHQ.

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HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Requirements: Expertise Nursing Job Type Full-Time Regular Location TELECOMMUTE, TX - Richardson, TX - San Antonio


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