Sr Manager Network Programs

Job ID: MBW-1018114 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".

Job Purpose:

This position is responsible for managing the functions of delegated utilization, case, and disease management oversight, physician quality oversight, and accreditation for commercial, exchange, and government HMO networks. Manages a professional nursing staff engaged in quality improvement activities and cost containment initiatives. Manages non-clinical staff engaged in monitoring of network provider offices and chart review. Manages the NCQA and URAC accreditation activities and ensures compliance with standards.

Required Job Qualifications:

  • Bachelor Degree and 5 years in a Healthcare setting.
  • Registered Nurse with 5 years of clinical experience.
  • 3 years supervisory or management experience.
  • Experience in Case Management, Utilization Management and Disease Management.
  • Knowledge of regulatory and accreditation requirements and standards (NCQA,URAC).
  • Experience in managing delegated oversight programs.
  • Knowledge of quality management, utilization management, and medical practices.
  • Verbal and written communication skills.
  • Proficient in Microsoft Office (Word, Excel, PowerPoint)

Preferred Job Qualifications:

  • Certification in UM, CM or DM.
  • Experience in developing or implementing managed care quality improvement programs.
  • Experience participating in or leading NCQA Surveys.
  • Experience in Government Programs (Medicare, Medicare Advantage, Medicaid).

Position is located in Chicago

Relocation is not available

Sponsorship not available


  • CB*
  • CA

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

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