Senior Manager Clinical Operations

Job ID: KB-1020181 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 leading and managing the development, implementation, strategic day-to-day administration of managed care operations in a variety of clinical functions such as Utilization Management, Case Management and Disease Management. Establish and lead team efforts, communications, protocols and procedures for managed care activities ensuring the cost effectiveness of health care delivery by an ongoing coordination with other internal departments. Meet/exceed internal and external customer service expectations.

JOB REQUIREMENTS:

  • Registered Nurse (RN) with 2 years direct clinical experience to the consumer.
  • 2 years supervisory experience in a utilization management role.
  • 4 years of corporate managed care experience in Case Management or Condition Management.
  • Knowledge of medical management/nursing practices.
  • PC experience to include Microsoft Word, Excel, PowerPoint.
  • Analytical skills including presenting clinical/operational recommendations to executive management, Medical Directors, or external clients.
  • Problem solving skills.
  • Presentation skills including presenting information clearly, concisely, and in a positive manner to internal and external customers.
  • Knowledge of Utilization Management metrics, HEDIS and regulatory bodies such as NCQA and URAC.

PREFERRED JOB REQUIREMENTS:

  • Certification in UM, CM or DM.
  • Bachelor or advanced degree.
  • Six Sigma or LEAN certification.
  • Wellcoach, Health Coach or Motivational Interviewing certification.
  • CCM preferred or ability to obtain in 18 months

LI-POST

  • CB*
  • CA

Requirements: Expertise Nursing Job Type Full-Time Regular Location TX - Richardson


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