Director Clinical Operations

Job ID: BDP-1020154 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.

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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".

BASIC FUNCTION:

This position is responsible for directing a variety of clinical functions of case management, disease management, and/or utilization management. Establish or implement cost-containment goals, objectives, metrics, and Return on Investment (ROI) targets for Medical Care Management Programs. Ensure staff meet/exceed goals and standards. Ensure compliance with certification and accreditation entities as well as government (HIPAA/ERISA/Department of Labor) programs. Implement Policies/Procedures and Training Programs to support the Department; and represent HCSC and the Division before outside customers and agencies.

JOB REQUIREMENTS:

  • Registered Nurse (RN) with current, valid license in state of operations.
  • 3 years clinical nursing experience.
  • 5 years people management experience.
  • 8 years medical management experience.
  • Experience and skills in influencing, leading and directing individuals in multiple functional areas.
  • Project management experience in the planning, implementation, and controlling of Medical projects.
  • Knowledge of various accreditation standards, i.e., NCQA, URAC, etc.
  • Knowledge of managed care principles and delivery systems.
  • Familiar with claims payment rules and their impact on care management processes.
  • Knowledge of healthcare/insurance industry (external market) current and future trends, to assess future market needs.
  • Knowledge of service delivery processes, workflow, systems, reporting needs, training and quality.
  • Organizational skills and ability to function cooperatively to achieve organizational goals and objectives.
  • Communication, leadership, team building, and quantitative analysis skills.
  • PC proficiency including familiarity with various software programs i.e., Work, Excel, PowerPoint, Access, etc.

PREFERRED JOB REQUIREMENTS:

  • Certification in Case Management, Health Care Administration or Project Management.

Requirements: Expertise Nursing Job Type Full-Time Regular Location IL - Chicago


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