Sr Director Custom Clinical Program

Job ID: BDP-1020261 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 the following functions: Directing the authorization, medical necessity determination, case/disease management, and Medical Care Management activities for a national account; Establishing cost-containment goals, objectives, metrics, and Return on Investment (ROI) targets for Medical Care Management Programs; Ensuring compliance with all certification and accreditation entities (TDI/URAC/NCQA) as well as government (HIPAA/ERISA/Department of Labor) programs; Directing the development and implementation of Policies/Procedures and Training Programs; and Representing the company before outside customers.

JOB REQUIREMENTS:

  • Bachelor Degree in healthcare field with 8 hears health care experience.
  • Registered Nurse (RN) currently licensed in Illinois in good standing with 3 years clinical nursing experience.
  • 8 years 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 to handle multiple functional areas.
  • Interpersonal skills to achieve organizational goals and objectives through collaboration. Management skills to achieve goals and objectives through others.
  • Communication, leadership and teambuilding skills.
  • Quantitative analytical skills.
  • Proficient PC skills 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 TX - Richardson


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